Provider Demographics
NPI:1558392217
Name:BRENNER, JEFFREY CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CRAIG
Last Name:BRENNER
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:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08101-0556
Mailing Address - Country:US
Mailing Address - Phone:856-541-6800
Mailing Address - Fax:856-541-1636
Practice Address - Street 1:639 COOPER ST
Practice Address - Street 2:HEALTH CENTER
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1116
Practice Address - Country:US
Practice Address - Phone:856-541-6800
Practice Address - Fax:856-541-1636
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7765509Medicaid
NJ024146RMEMedicare ID - Type UnspecifiedMEDICARE NUMBER
NJ7765509Medicaid