Provider Demographics
NPI:1689799447
Name:BRENNAN, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:BRENNAN
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 1:220 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5713
Mailing Address - Country:US
Mailing Address - Phone:718-222-3636
Mailing Address - Fax:718-222-4921
Practice Address - Street 1:220 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5713
Practice Address - Country:US
Practice Address - Phone:718-222-3636
Practice Address - Fax:718-222-4921
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174425207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
88738OtherAETNA US HEALTHCARE
KP152OtherOXFORD HEALTH PLANS
4C4455OtherHEALTHNET
NY0075872OtherGHI
NY01155706Medicaid
NY47F581OtherEMPIRE BCBS
NY47F581Medicare ID - Type Unspecified
NY01155706Medicaid