MEDICARE: BRAGA UROLOGIC LLC

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1942854724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAGA UROLOGIC LLC

Provider Business Mailing Address
First Line	:	106 COURT HOUSE SOUTH DENNIS RD STE 201
Second Line	:
City	:	CAPE MAY COURT HOUSE
State	:	NJ
Zip	:	08210-2126
Country	:	US
Telephone Number	:	609-465-4404
Fax Number	:	609-653-4176

Provider Business Practice Location Address
First Line	:	106 COURT HOUSE SOUTH DENNIS RD STE 201
Second Line	:
City	:	CAPE MAY COURT HOUSE
State	:	NJ
Zip	:	08210-2126
Country	:	US
Telephone Number	:	609-465-4404
Fax Number	:	609-653-4176

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. GAIL MARIE SIMERSON
Credential	:
Telephone Number	:	609-653-4343

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	07/30/2019

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