Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 211330 | NY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 211330 | NY |
NPI | 1154353977 |
---|---|
Provider Name | Dr. John J Brennan |
First Address | East Setauket, NY 11733-4079 |
Second Address | East Setauket, NY 11733-4079 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 24/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G99272 | (02) | NY |