Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 857 | NJ |
Y | 222Z00000X | Podiatrist | 857 | NJ |
NPI | 1063432193 |
---|---|
Provider Name | Dr. Gerald I Bresner |
First Address | Denville, NJ 07834-2735 |
Second Address | Denville, NJ 07834-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 17/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5019850001 | DME (01) | NJ |
6083005 | (05) | NJ |
T44591 | (02) | NJ |