Basic Information
Provider Information | |||||||||
NPI: | 1073818092 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | JUDY BRASIER DO, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4 HILLTOP DR | ||||||||
Address2: |   | ||||||||
City: | MILLIS | ||||||||
State: | MA | ||||||||
PostalCode: | 020541761 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5085793452 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 200 PROVIDENCE HWY | ||||||||
Address2: | SUITE 200 | ||||||||
City: | DEDHAM | ||||||||
State: | MA | ||||||||
PostalCode: | 020261881 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7814614543 | ||||||||
FaxNumber: | 7813262030 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/22/2011 | ||||||||
LastUpdateDate: | 01/22/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BRASIER | ||||||||
AuthorizedOfficialFirstName: | JUDY | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 5085793452 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | D.O. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 226380 | MA | N |   | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QM2500X | 226380 | MA | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.