Provider Demographics
NPI:1760595516
Name:CANAVAN, BRIAN F (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:F
Last Name:CANAVAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 CRANBURY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4096
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:732-390-7725
Practice Address - Street 1:34-36 PROGRESS STREET
Practice Address - Street 2:SUITE B2
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:908-757-9696
Practice Address - Fax:908-757-9721
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05551400207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F03506OtherACS
110108158OtherUNITED HEALTHCARE MEDI
P788711OtherOXFORD HEALTHCARE MEDI
223254679001OtherQUALCARE
NJ1790396281OtherTITAN HEALTH GROUP NPI#
J021315OtherCHAMPUS
P788711OtherOXFORD HEALTH PLANS
F03506OtherHEALTH NET
0469749OtherAETNA
0469749OtherUS HEALTHCARE
223254679OtherBLUE SHIELD HORIZON
NJ1790396281OtherTITAN HEALTH NPI GROUP #
NJ6556906Medicaid