Provider Demographics
NPI:1922291848
Name:BRIGLIA, WILLIAM JOSEPH SR (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:BRIGLIA
Suffix:SR
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 1:4293 RT 47
Mailing Address - Street 2:MEDICAL DEPT BAYSIDE STATE PRISON
Mailing Address - City:LEESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08327
Mailing Address - Country:US
Mailing Address - Phone:856-785-9370
Mailing Address - Fax:856-785-9262
Practice Address - Street 1:4293 RT 47
Practice Address - Street 2:MEDICAL DEPT BAYSIDE STATE PRISON
Practice Address - City:LEESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08327
Practice Address - Country:US
Practice Address - Phone:856-785-9370
Practice Address - Fax:856-785-9262
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05471600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5992605Medicaid
NJF58233Medicare UPIN
NJ5992605Medicaid