Basic Information
Provider Information | |||||||||
NPI: | 1316502438 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BRITO | ||||||||
FirstName: | DANIEL | ||||||||
MiddleName: | E | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | L.P.N | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 188 BOYLE AVE | ||||||||
Address2: |   | ||||||||
City: | TOTONA | ||||||||
State: | NJ | ||||||||
PostalCode: | 07512 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2019162929 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 163 E MAIN ST 2ND FLOOR | ||||||||
Address2: |   | ||||||||
City: | LITTLE FALLS | ||||||||
State: | NJ | ||||||||
PostalCode: | 07424 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9738120030 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/03/2019 | ||||||||
LastUpdateDate: | 05/03/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 26NP06818400 | NJ | Y |   | Nursing Service Providers | Licensed Practical Nurse |   |
No ID Information.