Healthcare Provider Details

I. General information

NPI: 1497093009
Provider Name (Legal Business Name): ANGELICA J BREWER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2013
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3548 ROUTE 9 SUITE 2
OLD BRIDGE NJ
08857-2765
US

IV. Provider business mailing address

1300 N HOLOPONO ST STE 215
KIHEI HI
96753-6945
US

V. Phone/Fax

Practice location:
  • Phone: 732-679-6738
  • Fax: 732-679-9566
Mailing address:
  • Phone: 808-874-3444
  • Fax: 808-874-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00300800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: