Provider Demographics
NPI:1942854724
Name:BRAGA UROLOGIC LLC
Entity type:Organization
Organization Name:BRAGA UROLOGIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SIMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-653-4343
Mailing Address - Street 1:106 COURT HOUSE SOUTH DENNIS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2126
Mailing Address - Country:US
Mailing Address - Phone:609-465-4404
Mailing Address - Fax:609-653-4176
Practice Address - Street 1:106 COURT HOUSE SOUTH DENNIS RD STE 201
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2126
Practice Address - Country:US
Practice Address - Phone:609-465-4404
Practice Address - Fax:609-653-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty