Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 25MA09660400 | NJ |
NPI | 1184884140 |
---|---|
Provider Name | Dr. Justin Samuel Brandt |
First Address | New Brunswick, NJ 08901-1962 |
Second Address | New Brunswick, NJ 08901-1962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 30/08/2016 |