Provider Demographics
NPI:1609054352
Name:BRANDT, JANET (FNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LILY CT
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-2533
Mailing Address - Country:US
Mailing Address - Phone:914-302-7531
Mailing Address - Fax:
Practice Address - Street 1:69 TOWNSEND CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1522
Practice Address - Country:US
Practice Address - Phone:914-302-7531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY473801163W00000X
NYF332787363LF0000X
NJ26NJ00375400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW06761OtherMEDICARE GROUP NUMBER
NYCA0060OtherRAILROAD MEDICARE GRP NUM
NY00547351OtherMEDICAID GROUP NUMBER
NY00547351OtherMEDICAID GROUP NUMBER