Provider Demographics
NPI:1477507192
Name:FORWARD, JOHN BRENT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRENT
Last Name:FORWARD
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 1:195 ROUTE #46
Mailing Address - Street 2:STE #102
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-3164
Mailing Address - Country:US
Mailing Address - Phone:973-366-6060
Mailing Address - Fax:973-366-1423
Practice Address - Street 1:195 ROUTE #46
Practice Address - Street 2:STE #102
Practice Address - City:MINE HILL
Practice Address - State:NJ
Practice Address - Zip Code:07803-3164
Practice Address - Country:US
Practice Address - Phone:973-366-6060
Practice Address - Fax:973-366-1423
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF0450686Medicare ID - Type Unspecified
C55119Medicare UPIN