Basic Information
Provider Information | |||||||||
NPI: | 1154419851 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BRESCH | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1225 WHITEHORSE MERCERVILLE RD | ||||||||
Address2: | BUILDING D, SUITE 203 | ||||||||
City: | HAMILTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 086193882 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6095816087 | ||||||||
FaxNumber: | 6095819561 | ||||||||
Practice Location | |||||||||
Address1: | 1225 WHITEHORSE MERCERVILLE RD | ||||||||
Address2: | BUILDING D, SUITE 203 | ||||||||
City: | HAMILTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 086193882 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6095816087 | ||||||||
FaxNumber: | 6095819561 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/10/2006 | ||||||||
LastUpdateDate: | 05/08/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 25MA07633900 | NJ | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | MD072786L | PA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084S0012X | 25MA07633900 | NJ | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine | 2084S0012X | MD072786L | PA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
ID | Type | State | Issuer | Description | 723510000 | 01 |   | MAGELLAN | OTHER | 7607642 | 01 |   | AETNA | OTHER | 6691330 | 01 | NJ | B/S NJ | OTHER | 1623376 | 01 |   | PA B/S | OTHER |