Provider Demographics
NPI:1922513183
Name:SD MIDDLETOWN
Entity Type:Organization
Organization Name:SD MIDDLETOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESLOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-876-9075
Mailing Address - Street 1:1000 HWY 35 STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2609
Mailing Address - Country:US
Mailing Address - Phone:732-361-6855
Mailing Address - Fax:
Practice Address - Street 1:1000 HWY 35 STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2609
Practice Address - Country:US
Practice Address - Phone:732-361-6855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty