Gary M Brousell, D.D.S.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

22DI0106000 Issued in NJ

Practice address

21 Gilbert Street
Tinton Falls, NJ 07724

Phone

(732) 747-0993

Fax

(732) 747-0961

NPI assigned

Jan 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1356311302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 WARDELL CIR",
            "city": "OCEANPORT",
            "state": "NJ",
            "postal_code": "077571610",
            "telephone_number": "732-747-0993",
            "fax_number": "732-747-0961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GILBERT STREET",
            "city": "TINTON FALLS",
            "state": "NJ",
            "postal_code": "07724",
            "telephone_number": "732-747-0993",
            "fax_number": "732-747-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSELL",
        "first_name": "GARY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "10690",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI0106000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1863401",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral & Maxillofacial Surgery (D.M.D.) in Tinton Falls, NJ
• Providers in Tinton Falls, NJ by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.