Provider Demographics
NPI:1578517645
Name:WILLIAM F. BRENNAN D.O.,P.A.
Entity Type:Organization
Organization Name:WILLIAM F. BRENNAN D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-468-5184
Mailing Address - Street 1:145 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1011
Mailing Address - Country:US
Mailing Address - Phone:856-468-5184
Mailing Address - Fax:856-468-7370
Practice Address - Street 1:145 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:NJ
Practice Address - Zip Code:08051-1011
Practice Address - Country:US
Practice Address - Phone:856-468-5184
Practice Address - Fax:856-468-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-21
Last Update Date:2007-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03184700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ163504Medicare PIN