MEDICARE: DR. PAUL FREDERICK BRENNER DSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC00021600	NJ

General Provider Information

NPI Number	:	1578552162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL FREDERICK BRENNER DSW

Provider Business Mailing Address
First Line	:	929 SYCAMORE AVE
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-3131
Country	:	US
Telephone Number	:	732-389-2484
Fax Number	:	732-389-2014

Provider Business Practice Location Address
First Line	:	929 SYCAMORE AVE
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-3131
Country	:	US
Telephone Number	:	732-389-2484
Fax Number	:	732-389-2014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/08/2007

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