Provider Demographics
NPI:1841987252
Name:GEMAL, BRACHA (PA-C)
Entity type:Individual
Prefix:
First Name:BRACHA
Middle Name:
Last Name:GEMAL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ESTI CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4053
Mailing Address - Country:US
Mailing Address - Phone:732-781-6805
Mailing Address - Fax:
Practice Address - Street 1:500 RIVER AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4738
Practice Address - Country:US
Practice Address - Phone:732-339-7360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00774200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical