Provider Demographics
NPI:1265469480
Name:BRESCIA, DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:BRESCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 ROUTE 31 N
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-3607
Mailing Address - Country:US
Mailing Address - Phone:609-737-2714
Mailing Address - Fax:609-737-1081
Practice Address - Street 1:132 ROUTE 31 N
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-3607
Practice Address - Country:US
Practice Address - Phone:609-737-2714
Practice Address - Fax:609-737-1081
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03003900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53167Medicare UPIN
090495Medicare PIN
222231665Medicare ID - Type UnspecifiedFEDERAL TAX I.D. NUMBER