Provider Demographics
NPI:1235359019
Name:BRENNER, LAURA ENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ENNIS
Last Name:BRENNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 COUNTY RD
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626-2201
Mailing Address - Country:US
Mailing Address - Phone:201-871-7799
Mailing Address - Fax:201-871-7799
Practice Address - Street 1:135 COUNTY RD
Practice Address - Street 2:SUITE 2C
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2201
Practice Address - Country:US
Practice Address - Phone:201-871-7799
Practice Address - Fax:201-871-7799
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA053348002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B41871Medicare UPIN
NJBR442070Medicare ID - Type Unspecified