Provider Demographics
NPI:1366503682
Name:BREZINSKI, ROBERT RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RAYMOND
Last Name:BREZINSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:RAYMOND
Other - Last Name:BREZINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:530 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1238
Mailing Address - Country:US
Mailing Address - Phone:908-276-2245
Mailing Address - Fax:908-276-8659
Practice Address - Street 1:530 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1238
Practice Address - Country:US
Practice Address - Phone:908-276-2245
Practice Address - Fax:908-276-8659
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00157300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45630Medicare UPIN
NJ508921Medicare PIN