Provider Demographics
NPI:1952366353
Name:SNELL, BRUCE HENRY III (MA, CO, ATC)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:HENRY
Last Name:SNELL
Suffix:III
Gender:M
Credentials:MA, CO, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2906
Mailing Address - Country:US
Mailing Address - Phone:781-727-5893
Mailing Address - Fax:
Practice Address - Street 1:140 N RTE 17
Practice Address - Street 2:SUITE 115
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2809
Practice Address - Country:US
Practice Address - Phone:201-225-9025
Practice Address - Fax:201-225-9030
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
NJ45OR00010100222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer