Provider Demographics
NPI:1255373726
Name:BRASLAVSKY, GREGORY (MD, PC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:BRASLAVSKY
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 PAVILION AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6415
Mailing Address - Country:US
Mailing Address - Phone:732-222-4740
Mailing Address - Fax:732-222-9345
Practice Address - Street 1:127 PAVILION AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6415
Practice Address - Country:US
Practice Address - Phone:732-222-4740
Practice Address - Fax:732-222-9345
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA066429174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG81158Medicare UPIN
020392Medicare ID - Type Unspecified