Provider Demographics
NPI:1134165426
Name:BRANWELL, JOHN P
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:BRANWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:PAUL
Other - Last Name:BRANWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:37 SEELEY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1806
Mailing Address - Country:US
Mailing Address - Phone:201-998-9700
Mailing Address - Fax:201-998-4899
Practice Address - Street 1:37 SEELEY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1806
Practice Address - Country:US
Practice Address - Phone:201-998-9700
Practice Address - Fax:201-998-4899
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002097213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5553806Medicaid
NJ040715Medicare PIN
NJU33097Medicare UPIN
NJ1737120001Medicare NSC