Healthcare Provider Details

I. General information

NPI: 1861461212
Provider Name (Legal Business Name): GARY D BRESLOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W RIDGEWOOD AVE
PARAMUS NJ
07652-2359
US

IV. Provider business mailing address

1 W RIDGEWOOD AVE
PARAMUS NJ
07652-2361
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-9522
  • Fax: 201-444-9277
Mailing address:
  • Phone: 201-444-9522
  • Fax: 201-444-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMA07627100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberMA07627100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: