Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MB52098 | NJ |
NPI | 1306816301 |
---|---|
Provider Name | Thomas E Brandeisky |
First Address | Brick, NJ 08724-3009 |
Second Address | Brick, NJ 08724-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 23/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F44968 | (02) | NJ |