Provider Demographics
NPI:1255360343
Name:BRIELLE OBSTETRICS & GYNECOLOGY, PA
Entity type:Organization
Organization Name:BRIELLE OBSTETRICS & GYNECOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-528-6999
Mailing Address - Street 1:2671 HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2605
Mailing Address - Country:US
Mailing Address - Phone:732-528-6999
Mailing Address - Fax:732-528-3397
Practice Address - Street 1:2671 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2605
Practice Address - Country:US
Practice Address - Phone:732-528-6999
Practice Address - Fax:732-528-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1934000000X207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2904900Medicaid
NJ2904900Medicaid