Provider Demographics
NPI: | 1942854724 |
---|---|
Name: | BRAGA UROLOGIC LLC |
Entity Type: | Organization |
Organization Name: | BRAGA UROLOGIC LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRACTICE MANAGER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | GAIL |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | SIMERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 609-653-4343 |
Mailing Address - Street 1: | 106 COURT HOUSE SOUTH DENNIS RD STE 201 |
Mailing Address - Street 2: | |
Mailing Address - City: | CAPE MAY COURT HOUSE |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08210-2126 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 609-465-4404 |
Mailing Address - Fax: | 609-653-4176 |
Practice Address - Street 1: | 106 COURT HOUSE SOUTH DENNIS RD STE 201 |
Practice Address - Street 2: | |
Practice Address - City: | CAPE MAY COURT HOUSE |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08210-2126 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-465-4404 |
Practice Address - Fax: | 609-653-4176 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-07-30 |
Last Update Date: | 2019-07-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Single Specialty |