Provider Demographics
NPI:1578567350
Name:BROSLAWSKI, GREGORY E (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:BROSLAWSKI
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 1:6 SAND HILL RD
Mailing Address - Street 2:STE 201
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4946
Mailing Address - Country:US
Mailing Address - Phone:908-782-8019
Mailing Address - Fax:908-782-7195
Practice Address - Street 1:6 SAND HILL RD
Practice Address - Street 2:STE 201
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4946
Practice Address - Country:US
Practice Address - Phone:908-782-8019
Practice Address - Fax:908-782-7195
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2020-08-21
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
NJMB55657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070862Medicare PIN
NJF62148Medicare UPIN