Individual
SALLYAN BRUNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.A.
Contact information
Practice address
874 W BROADWAY, C2, WOODMERE, NY 11598-2057
(201) 456-3527
Mailing address
874 W BROADWAY, C2, WOODMERE, NY 11598-2057
(201) 456-3527
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
924736
NJ
Other
Enumeration date
06/04/2014
Last updated
06/04/2014
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