Provider Demographics
NPI:1275564825
Name:HAMPTON ORTHOPEDIC AND SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:HAMPTON ORTHOPEDIC AND SPORTS MEDICINE PC
Other - Org Name:JOHN J. BRENNAN, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-287-9477
Mailing Address - Street 1:325 MEETING HOUSE LN BLDG 2
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5087
Mailing Address - Country:US
Mailing Address - Phone:631-287-9477
Mailing Address - Fax:631-287-9751
Practice Address - Street 1:325 MEETING HOUSE LN BLDG 2
Practice Address - Street 2:SUITE 301
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5087
Practice Address - Country:US
Practice Address - Phone:631-287-9477
Practice Address - Fax:631-287-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211330 1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID
NYWCJ691Medicare ID - Type UnspecifiedGROUP PROVIDER ID