Provider Demographics
NPI:1861269813
Name:BREVAL, EMMANUELA
Entity type:Individual
Prefix:
First Name:EMMANUELA
Middle Name:
Last Name:BREVAL
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 1:178 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2676
Mailing Address - Country:US
Mailing Address - Phone:240-601-5475
Mailing Address - Fax:
Practice Address - Street 1:178 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2676
Practice Address - Country:US
Practice Address - Phone:240-601-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NH10284500374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide