Gary Brousell, D.D.S.PA

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DI10690 Issued in NJ

Legal business name

GARY BROUSELL, D.D.S.PA

Practice address

21 Gilbert St.
Tinton Fall, NJ 07724

Phone

(732) 747-0993

Fax

(732) 747-0961

NPI assigned

Feb 2, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gary M Brousell, D.D.S.NPI 1356311302

Title

President

Phone

(732) 747-0993

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary M Brousell, D.D.S.

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Tinton Falls, NJ
  • NPI 1356311302
  Authorized official Same address or phone

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760520670",
    "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": "732-539-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GILBERT ST.",
            "city": "TINTON FALL",
            "state": "NJ",
            "postal_code": "07724",
            "telephone_number": "732-747-0993",
            "fax_number": "732-747-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY BROUSELL, D.D.S.PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROUSELL",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-747-0993",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "DI10690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1863401",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.