Healthcare Provider Details

I. General information

NPI: 1699706598
Provider Name (Legal Business Name): KRISTIN L BRILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ SUITE 411
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

1100 WALNUT STREET MOB 5TH FLOOR
PHILADELPHIA PA
19107-5563
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2270
  • Fax: 856-365-1180
Mailing address:
  • Phone: 215-955-6750
  • Fax: 215-923-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD073364L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA07237800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: