Healthcare Provider Details

I. General information

NPI: 1154478246
Provider Name (Legal Business Name): BRIELLE ORTHOPEDICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 JACK MARTIN BLVD
BRICK NJ
08724-7776
US

IV. Provider business mailing address

457 JACK MARTIN BLVD
BRICK NJ
08724-7776
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-7500
  • Fax: 732-840-2088
Mailing address:
  • Phone: 732-840-7500
  • Fax: 732-840-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH P BOGDAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 732-840-7500