Basic Information
Provider Information | |||||||||
NPI: | 1033449962 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BROGNERI | ||||||||
FirstName: | DANA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT, DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10 ROY CT | ||||||||
Address2: |   | ||||||||
City: | SUSSEX | ||||||||
State: | NJ | ||||||||
PostalCode: | 074611518 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9736706929 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 222 HIGH ST | ||||||||
Address2: | NORMAN SILBERT BUILDING, SUITE 203 | ||||||||
City: | NEWTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 078609604 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9733833822 | ||||||||
FaxNumber: | 9733833814 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/26/2009 | ||||||||
LastUpdateDate: | 12/26/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01275300 | NJ | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.