Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 25MA05843200 | NJ |
NPI | 1508900069 |
---|---|
Provider Name | Dr. John Andrew Brennan |
First Address | Randolph, NJ 07869-2022 |
Second Address | West Orange, NJ 07052-1008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5398401 | (05) | NJ |
A53388 | (02) |