Healthcare Provider Details

I. General information

NPI: 1790969202
Provider Name (Legal Business Name): MARY ANNE BRAZINSKI DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3453 VALLEY RD
BASKING RIDGE NJ
07920-2655
US

IV. Provider business mailing address

3453 VALLEY RD
BASKING RIDGE NJ
07920-2655
US

V. Phone/Fax

Practice location:
  • Phone: 908-604-2277
  • Fax: 908-604-6219
Mailing address:
  • Phone: 908-604-2277
  • Fax: 908-604-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMD01616
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD0616
License Number StateNJ

VIII. Authorized Official

Name: DR. MARY ANNE BRAZINSKI
Title or Position: DOCTOR
Credential: DPM
Phone: 908-604-2277