Provider Demographics
NPI:1629185491
Name:O'BRIEN, DENNIS (DPM)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 STELTON RD
Mailing Address - Street 2:SUITE E3
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-3284
Mailing Address - Country:US
Mailing Address - Phone:732-968-9494
Mailing Address - Fax:732-968-4703
Practice Address - Street 1:216 STELTON RD
Practice Address - Street 2:SUITE E3
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3284
Practice Address - Country:US
Practice Address - Phone:732-968-9494
Practice Address - Fax:732-968-4703
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01599213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ534719Medicare ID - Type Unspecified
NJU26457Medicare UPIN