# BRIDGECARE PROVIDER GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164148672
- **Authorized official:** DR. IYAD BAKER (OWNER)
- **Authorized official phone:** (201) 596-6262

## Contact information

- **Practice address:** 493 BLACK OAK RIDGE RD, WAYNE, NJ 07470-6501
- **Practice address phone:** (973) 692-9500
- **Mailing address:** 173 BRIDGE PLZ N, FORT LEE, NJ 07024-7575

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TA0700X | Adult Development & Aging Psychologist | — | NULL | — |
| 103TA0700X | Adult Development & Aging Psychologist | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/17/2022
- **Last updated:** 10/17/2022