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General NPI Number Information
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NPI Number | 1558241224
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Entity Type | Individual
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Provider Name | EZEREA BRASSINGTON
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Gender |
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 1000 RIVER RD
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City | TEANECK
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State | NJ
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Zip | 07666-1938
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Country | US
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Telephone | 201-692-2882
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Fax |
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Provider Business Mailing Address
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Address Line | 11 LEE CT
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-3027
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Country | US
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Telephone | 973-715-8771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 26NR23014800
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License Number State | NJ
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