Provider Demographics
NPI:1841808516
Name:AYALA, BRIANNA (NP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEW EGYPT
Mailing Address - State:NJ
Mailing Address - Zip Code:08533-2113
Mailing Address - Country:US
Mailing Address - Phone:631-885-5119
Mailing Address - Fax:
Practice Address - Street 1:402 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:NEW EGYPT
Practice Address - State:NJ
Practice Address - Zip Code:08533-2113
Practice Address - Country:US
Practice Address - Phone:631-885-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17091400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics