Provider Demographics
NPI:1124722822
Name:HIDALGO, BRIANA NICOLE
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:NICOLE
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1815
Mailing Address - Country:US
Mailing Address - Phone:201-470-1530
Mailing Address - Fax:
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5711
Practice Address - Country:US
Practice Address - Phone:201-470-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01457900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist