Provider Demographics
NPI:1235887639
Name:BREYER, GARRETT MICHAEL
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:MICHAEL
Last Name:BREYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1211
Mailing Address - Country:US
Mailing Address - Phone:856-361-2850
Mailing Address - Fax:
Practice Address - Street 1:9 N 9TH ST UNIT 814
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3157
Practice Address - Country:US
Practice Address - Phone:732-832-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program