MEDICARE: MR. CARL BRESCIA

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	2084N0400X	Neurology Physician	025724	NY
2	363A00000X	Physician Assistant	PA9114903	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	025724	OTHER	NY	NYS LICENSE

General Provider Information

NPI Number	:	1679125215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARL BRESCIA

Provider Business Mailing Address
First Line	:	3365 BURNS RD STE 203
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4303
Country	:	US
Telephone Number	:	561-402-3971
Fax Number	:	561-422-4799

Provider Business Practice Location Address
First Line	:	420 S STATE ROAD 7 STE 112
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4304
Country	:	US
Telephone Number	:	561-402-3971
Fax Number	:

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

Provider Enumeration Date	:	07/14/2019
Last Update Date	:	07/10/2023

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