Provider Demographics
NPI:1306816301
Name:BRANDEISKY, THOMAS E (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:BRANDEISKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 ROUTE 88
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3009
Mailing Address - Country:US
Mailing Address - Phone:732-458-8575
Mailing Address - Fax:732-206-0578
Practice Address - Street 1:1608 ROUTE 88
Practice Address - Street 2:SUITE 240
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3009
Practice Address - Country:US
Practice Address - Phone:732-458-8575
Practice Address - Fax:732-206-0578
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB52098207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF44968Medicare UPIN
NJ604020MVLMedicare ID - Type Unspecified