Provider Demographics
NPI:1902425424
Name:BRIDGE TO LIFE CLINICAL CONSULTANTS, LLC
Entity Type:Organization
Organization Name:BRIDGE TO LIFE CLINICAL CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:I
Authorized Official - Last Name:NKATTA-ABONGWA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:732-259-2609
Mailing Address - Street 1:26 FERN CT
Mailing Address - Street 2:
Mailing Address - City:SAYREVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08872-2103
Mailing Address - Country:US
Mailing Address - Phone:848-444-1962
Mailing Address - Fax:
Practice Address - Street 1:811 WASHINGTON RD STE 1B
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1078
Practice Address - Country:US
Practice Address - Phone:848-444-1962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care