Provider Demographics
NPI:1063432193
Name:BRESNER, GERALD I (DPM)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:I
Last Name:BRESNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ857213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6083005Medicaid
NJ5019850001OtherDME
NJ042369Medicare PIN
NJ5019850001OtherDME