Provider Demographics
NPI:1679125215
Name:BRESCIA, CARL
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:BRESCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 BURNS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4303
Mailing Address - Country:US
Mailing Address - Phone:561-402-3971
Mailing Address - Fax:561-422-4799
Practice Address - Street 1:420 S STATE ROAD 7 STE 112
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4304
Practice Address - Country:US
Practice Address - Phone:561-402-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0257242084N0400X
FLPA9114903363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY025724OtherNYS LICENSE