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NPI Code Detail

MEDICARE: DR. DAIVA BRAZAITIS MD

MEDICARE: DR. DAIVA BRAZAITIS 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
1207R00000XInternal Medicine Physician25MA07119200NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477555217
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAIVA BRAZAITIS MD
Provider Business Mailing Address
First Line : 66 W GILBERT ST
Second Line : SUITE 100
City : TINTON FALLS
State : NJ
Zip : 07701-4918
Country : US
Telephone Number : 721-212-0060
Fax Number : 732-212-0061
Provider Business Practice Location Address
First Line : 155 JEFFERSON ST
Second Line :
City : NEWARK
State : NJ
Zip : 07105-1706
Country : US
Telephone Number : 973-589-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 07/08/2007

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