Provider Demographics
NPI:1891759940
Name:TRUXAL, BRIAN ANDREW (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ANDREW
Last Name:TRUXAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MONMOUTH ROAD
Mailing Address - Street 2:
Mailing Address - City:W LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764
Mailing Address - Country:US
Mailing Address - Phone:732-229-4540
Mailing Address - Fax:732-229-8689
Practice Address - Street 1:223 MONMOUTH ROAD
Practice Address - Street 2:PEDIATRIC & ADOLESCENT MEDICINE PA
Practice Address - City:W LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764
Practice Address - Country:US
Practice Address - Phone:732-229-4540
Practice Address - Fax:732-229-8689
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA040400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0238201Medicaid
NJ0238201Medicaid