Provider Demographics
NPI:1619946431
Name:BRANNAN, TIMOTHY S (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:BRANNAN
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 1:377 JERSEY AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4393
Mailing Address - Country:US
Mailing Address - Phone:201-309-2380
Mailing Address - Fax:201-309-2381
Practice Address - Street 1:377 JERSEY AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4393
Practice Address - Country:US
Practice Address - Phone:201-309-2380
Practice Address - Fax:201-309-2381
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA650642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7262906Medicaid
NJ7262906Medicaid
NJ905699Medicare ID - Type Unspecified