Provider Demographics
NPI:1215424429
Name:O'DONOVAN, BRENDAN (DO)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:O'DONOVAN
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 1:59 VERONICA AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3579
Mailing Address - Country:US
Mailing Address - Phone:732-873-6868
Mailing Address - Fax:732-873-6869
Practice Address - Street 1:59 VERONICA AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3579
Practice Address - Country:US
Practice Address - Phone:732-873-6868
Practice Address - Fax:732-873-6869
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11802200208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine