Provider Demographics
NPI:1154419851
Name:BRESCH, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BRESCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:BUILDING D, SUITE 203
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3882
Mailing Address - Country:US
Mailing Address - Phone:609-581-6087
Mailing Address - Fax:609-581-9561
Practice Address - Street 1:1225 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:BUILDING D, SUITE 203
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3882
Practice Address - Country:US
Practice Address - Phone:609-581-6087
Practice Address - Fax:609-581-9561
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA076339002084P0800X, 2084S0012X
PAMD072786L2084P0800X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
723510000OtherMAGELLAN
7607642OtherAETNA
NJ6691330OtherB/S NJ
1623376OtherPA B/S
NJ083059Medicare ID - Type Unspecified
NJ6691330OtherB/S NJ
H62425Medicare UPIN