BRYAN LACKEY (NPI# 1891305645) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891305645 |
| Entity Type | Individual |
| Full Name | BRYAN LACKEY |
| Credential | PMHNP |
| Practice Address |
11 Garvey Rd Wayne NJ 07470-3628 |
| Practice Telephone | 2013962171 |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2020-08-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
26NJ01045800 | NJ | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
403117 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
11 GARVEY RD |
| City | WAYNE |
| State | NJ |
| Zip Code | 07470-3628 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558812347 | Amanda Favretto | Counselor | 11 Garvey Rd, Wayne, NJ 07470-3628 | 2016-10-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669073086 | Brightview Hamburg, LLC | Alzheimer Center (Dementia Center) | 1139 Hamburg Turnpike, Wayne, NJ 07470 | 2020-11-03 |
| 1912536301 | Stevenson Dominique | Physician Assistant | 1700 Nj-23 # 170, Wayne, NJ 07470 | 2020-04-07 |
| 1710524087 | Engel Burman At Wayne, LLC | Assisted Living Facility | 1440 Hamburg Turnpike, Wayne, NJ 07470 | 2019-12-05 |
| 1508412669 | Jessie Diana Dunitz | Technician | 66 Sandra Lane, Wayne, NJ 07470 | 2019-08-14 |
| 1447737234 | Meza Behavioral Health, Inc. | Psychologist | 40 Edgemont Crescent, Wayne, NJ 07470 | 2018-07-24 |
| 1881188076 | Christine Nolan | Occupational Therapist | 1 Pike Drive, Wayne, NJ 07470 | 2018-06-20 |
| 1033612403 | County of Passaic Department of Finance | Skilled Nursing Facility | 305 Oldham Road, Wayne, NJ 07470 | 2018-03-13 |
| 1144739590 | Broadway Respite and Home Care | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7 Allen Drive, Wayne, NJ 07470 | 2017-09-28 |
| 1679096697 | Wafaa Saad | Counselor | 1009 Valley Rd, Wayne, NJ 07470 | 2017-07-21 |
| 1659803138 | Allison Nicole Diangelo | Nurse Practitioner | 1578 Rte 23, Wayne, NJ 07470 | 2017-04-03 |
| Find all providers in zip 07470 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831513829 | Mamilda Robinson | Nurse Practitioner | 506 Hamburg Tpke Ste 209, Wayne, NJ 07470-2069 | 2014-02-11 |
| 1174158299 | Emily Coyle | Nurse Practitioner | 401 Hamburg Tpke, Wayne, NJ 07470-2154 | 2020-03-09 |
| 1235788092 | Mary Fitzgerald Switala | Nurse Practitioner | 401 Hamburg Tpke, Wayne, NJ 07470-2154 | 2019-09-04 |
| 1770038788 | Isaac O Omoloyin | Nurse Practitioner | 401 Hamburg Tpke, Suite 302, Wayne, NJ 07470-2154 | 2016-08-19 |
| 1538532379 | Brian Bigelow | Nurse Practitioner | 34841 Veterans Plz, Wayne, MI 48184-1733 | 2015-11-02 |
| 1285045757 | Diane Dettmore | Nurse Practitioner | 1340 Hamburg Tpke, Wayne, NJ 07470-4003 | 2014-05-18 |
| 1811263338 | Janet Randall | Nurse Practitioner | 1581 Route 23, Suite 1, Wayne, NJ 07470-7508 | 2012-03-29 |
| 1306959762 | Janet Drew Reynolds | Nurse Practitioner | 401 Hamburg Turnpike, Ste 303, Wayne, NJ 07470 | 2006-08-17 |
| 1467460626 | Maripat Alger Cottone | Nurse Practitioner | 401 Hamburg Tpke, Suite 303, Wayne, NJ 07470 | 2006-08-04 |
| 1225063605 | Linda B Berger | Nurse Practitioner | 401 Hamburg Tpke, Ste 303, Wayne, NJ 07470 | 2006-07-12 |
| Find all providers in WAYNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.