Provider Demographics
NPI:1871985218
Name:BRYANT, WILLIAM III
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:BRYANT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 VASSAR AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-1417
Mailing Address - Country:US
Mailing Address - Phone:973-482-9727
Mailing Address - Fax:973-482-9727
Practice Address - Street 1:254 VASSAR AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-1417
Practice Address - Country:US
Practice Address - Phone:973-482-9727
Practice Address - Fax:973-482-9727
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No175L00000XOther Service ProvidersHomeopath