Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 25MD00169400 | NJ |
N | 222Z00000X | Podiatrist | 25MD00169400 | NJ |
N | 213EP1101X | Primary Podiatric Medicine | 25MD00169400 | NJ |
N | 2081S0010X | Sports Medicine | 25MD00169400 | NJ |
N | 213ES0000X | Sports Medicine | 25MD00169400 | NJ |
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00169400 | NJ |
N | 213ES0131X | Foot Surgery | 25MD00169400 | NJ |
NPI | 1548231814 |
---|---|
Provider Name | Dr. John Arthur Brandeisky |
First Address | Freehold, NJ 07728-8308 |
Second Address | Freehold, NJ 07728-8308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 27/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T45629 | (02) | NJ |