MEDICARE: EZEREA BRASSINGTON

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	2084P0800X	Psychiatry Physician	26NR23014800	NJ

General Provider Information

NPI Number	:	1558241224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZEREA BRASSINGTON

Provider Business Mailing Address
First Line	:	11 LEE CT
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-3027
Country	:	US
Telephone Number	:	973-715-8771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 RIVER RD
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-1938
Country	:	US
Telephone Number	:	201-692-2882
Fax Number	:

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

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	09/04/2025

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Directions to “ EZEREA BRASSINGTON ” Practice Location

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