Provider Demographics
NPI:1740466861
Name:SPANO-BRENNAN, LIANA M (DO)
Entity type:Individual
Prefix:DR
First Name:LIANA
Middle Name:M
Last Name:SPANO-BRENNAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1820 STATE ROUTE 33
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4860
Mailing Address - Country:US
Mailing Address - Phone:732-776-8500
Mailing Address - Fax:732-776-8946
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-277-8700
Practice Address - Fax:908-673-7108
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08315300207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0167568Medicaid
NJ3543747000OtherAMERIHEALTH
NJ3543747000OtherAMERIHEALTH
NJ127647AXTMedicare PIN
NJ0167568Medicaid