MEDICARE: BRAELAN DROLLAS

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	363A00000X	Physician Assistant	25MP00987600	NJ

General Provider Information

NPI Number	:	1649138769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAELAN DROLLAS

Provider Business Mailing Address
First Line	:	23 WASHBURN PL
Second Line	:
City	:	CALDWELL
State	:	NJ
Zip	:	07006-5614
Country	:	US
Telephone Number	:	856-834-5276
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 WASHBURN PL
Second Line	:
City	:	CALDWELL
State	:	NJ
Zip	:	07006-5614
Country	:	US
Telephone Number	:	856-834-5276
Fax Number	:

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

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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Directions to “ BRAELAN DROLLAS ” Practice Location

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