Healthcare Provider Details

I. General information

NPI: 1942602123
Provider Name (Legal Business Name): BRENDAN PATRICK MCCOLLUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 280
GARDENA CA
90248-4305
US

IV. Provider business mailing address

19 HOLLY ST
CRANFORD NJ
07016-2158
US

V. Phone/Fax

Practice location:
  • Phone: 877-515-8113
  • Fax:
Mailing address:
  • Phone: 908-273-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA09556000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: