Provider Demographics
NPI:1437189297
Name:PRINCE, BRETT J
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:J
Last Name:PRINCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 ROUTE 88 W STE G
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2373
Mailing Address - Country:US
Mailing Address - Phone:732-836-9770
Mailing Address - Fax:732-836-9774
Practice Address - Street 1:1541 ROUTE 88 W STE G
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2373
Practice Address - Country:US
Practice Address - Phone:732-836-9770
Practice Address - Fax:732-836-9774
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03461103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS40657Medicare UPIN
NJ908845SA9Medicare ID - Type UnspecifiedRENDERING DR. #/INDL. GRP