Healthcare Provider Details

I. General information

NPI: 1295564417
Provider Name (Legal Business Name): EMILY BRENNAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INTERNATIONAL DR STE 2
BUDD LAKE NJ
07828-1383
US

IV. Provider business mailing address

30 SUSSEX AVE UNIT 1
MORRISTOWN NJ
07960-3885
US

V. Phone/Fax

Practice location:
  • Phone: 833-489-2622
  • Fax:
Mailing address:
  • Phone: 908-914-5054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: