Provider Demographics
NPI:1306849906
Name:BRAZINSKI, MARY ANNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:
Last Name:BRAZINSKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3453 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2655
Mailing Address - Country:US
Mailing Address - Phone:908-647-8429
Mailing Address - Fax:908-604-6219
Practice Address - Street 1:3453 VALLEY RD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2655
Practice Address - Country:US
Practice Address - Phone:908-604-2277
Practice Address - Fax:908-604-6219
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01616213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1821202Medicaid
NJ480007595OtherRAILROAD MEDICARE
NJT5115OtherOXFORD
NJ1502167001OtherCIGMA
NJ392906OtherUNITED HEALTH
NJ4792120001OtherMEDICARE DME
NJ1502167001OtherCIGMA
NJ480007595OtherRAILROAD MEDICARE
NJT45744Medicare UPIN