Provider Demographics
NPI:1346257417
Name:BRAND, MICHAEL M (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:BRAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FRANKLIN AVENUE
Mailing Address - Street 2:ROOM 307
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109
Mailing Address - Country:US
Mailing Address - Phone:973-751-5644
Mailing Address - Fax:973-751-5678
Practice Address - Street 1:5 FRANKLIN AVENUE
Practice Address - Street 2:ROOM 307
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109
Practice Address - Country:US
Practice Address - Phone:973-751-5644
Practice Address - Fax:973-751-5678
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA223612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2738201Medicaid
NJ2738201Medicaid
488386Medicare ID - Type Unspecified