Provider Demographics
NPI:1447832084
Name:BRIGNOLA, DANA (PA)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BRIGNOLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:181 FRANKLIN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2900
Mailing Address - Country:US
Mailing Address - Phone:973-667-8117
Mailing Address - Fax:973-667-6642
Practice Address - Street 1:181 FRANKLIN AVE STE 204
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2900
Practice Address - Country:US
Practice Address - Phone:862-208-9136
Practice Address - Fax:973-667-6642
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00059600363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant