Healthcare Provider Details

I. General information

NPI: 1750301115
Provider Name (Legal Business Name): WINSLOW PERCIVAL BRAITHWAITE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 NORTHFIELD AVE STE 304
WEST ORANGE NJ
07052-5344
US

IV. Provider business mailing address

1320 ADAMS ST STE DE
HOBOKEN NJ
07030-2370
US

V. Phone/Fax

Practice location:
  • Phone: 973-612-2214
  • Fax:
Mailing address:
  • Phone: 201-308-6622
  • Fax: 201-308-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003950
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00046300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: