Provider Demographics
NPI:1790969202
Name:MARY ANNE BRAZINSKI DPM PA
Entity Type:Organization
Organization Name:MARY ANNE BRAZINSKI DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-604-2277
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:908-604-2277
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD0616213E00000X
NJMD01616332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJTS115OtherOXFORD
NJ1502167001OtherCIGNA
NJ1821202Medicaid
NJ392906OtherUNITED HEALTHCARE
NJTS115OtherOXFORD
NJ1502167001OtherCIGNA
NJT45744Medicare UPIN