Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MA07627100 | NJ |
N | 208600000X | Surgeon | MA07627100 | NJ |
N | 2082S0105X | Plastic Hand Surgeon | MA07627100 | NJ |
NPI | 1861461212 |
---|---|
Provider Name | Dr. Gary D Breslow |
First Address | Paramus, NJ 07652-2361 |
Second Address | Paramus, NJ 07652-2359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I29208 | (02) | NJ |