Provider Demographics
NPI:1891791174
Name:BRAVER, JOEL (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:BRAVER
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 1:30 REHILL AVE
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2500
Mailing Address - Country:US
Mailing Address - Phone:908-927-8777
Mailing Address - Fax:908-927-8764
Practice Address - Street 1:30 REHILL AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-927-8777
Practice Address - Fax:908-927-8764
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA063408002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6922104Medicaid
NJG26927Medicare UPIN
NJ6922104Medicaid