Provider Demographics
NPI:1952716151
Name:IMBRIE, BRITTANI (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTANI
Middle Name:
Last Name:IMBRIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRITTANI
Other - Middle Name:
Other - Last Name:RAYBUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-7890
Mailing Address - Fax:
Practice Address - Street 1:235 GLEN COVE RD
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1221
Practice Address - Country:US
Practice Address - Phone:516-877-2273
Practice Address - Fax:516-877-2275
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056897363AM0700X, 390200000X
NY020754363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program