MEDICARE: DR. TIMOTHY BRABSTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MAO65228	NJ
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MAO65228	NJ

General Provider Information

NPI Number	:	1184607863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY BRABSTON MD

Provider Business Mailing Address
First Line	:	525 WANAQUE AVE
Second Line	:
City	:	POMPTON LAKES
State	:	NJ
Zip	:	07442-1843
Country	:	US
Telephone Number	:	973-839-3333
Fax Number	:	973-839-0580

Provider Business Practice Location Address
First Line	:	525 WANAQUE AVE
Second Line	:
City	:	POMPTON LAKES
State	:	NJ
Zip	:	07442-1843
Country	:	US
Telephone Number	:	973-839-3333
Fax Number	:	973-839-0580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	04/12/2011

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