Provider Demographics
NPI:1952924714
Name:BRECH, DYLAN T
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:T
Last Name:BRECH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 WILMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-5673
Mailing Address - Country:US
Mailing Address - Phone:908-910-0902
Mailing Address - Fax:
Practice Address - Street 1:70 RAMTOWN GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3830
Practice Address - Country:US
Practice Address - Phone:732-785-0300
Practice Address - Fax:732-785-9420
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB11743500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program