Provider Demographics
NPI:1669612099
Name:GERALD I BRESNER PC
Entity type:Organization
Organization Name:GERALD I BRESNER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:I
Authorized Official - Last Name:BRESNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-627-7090
Mailing Address - Street 1:75 BLOOMFIELD AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2735
Mailing Address - Country:US
Mailing Address - Phone:973-627-7090
Mailing Address - Fax:973-625-7767
Practice Address - Street 1:75 BLOOMFIELD AVE
Practice Address - Street 2:STE 106
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2735
Practice Address - Country:US
Practice Address - Phone:973-627-7090
Practice Address - Fax:973-625-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00085700213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5019850001Medicare NSC