Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MA60313 | NJ |
NPI | 1033215819 |
---|---|
Provider Name | Michael L Brescia |
First Address | Roselle Park, NJ 07204-2084 |
Second Address | Roselle Park, NJ 07204-2084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F57583 | (02) | NJ |