Provider Demographics
NPI:1326451642
Name:CERNIGLIA, BRETT (MD, MPH)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:CERNIGLIA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 S 11TH ST
Mailing Address - Street 2:APT# 1A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3701
Mailing Address - Country:US
Mailing Address - Phone:518-496-6829
Mailing Address - Fax:
Practice Address - Street 1:44 E JIMMIE LEEDS RD STE 101
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9599
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT206281207R00000X
NJ25MA107697002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1E2984OtherMEDICARE
NJ25MA10769700OtherSTATE MEDICAL LICENSE