Healthcare Provider Details

I. General information

NPI: 1760595516
Provider Name (Legal Business Name): BRIAN F CANAVAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PROGRESS ST STE 100
EDISON NJ
08820-1180
US

IV. Provider business mailing address

629 CRANBURY RD FL 2
EAST BRUNSWICK NJ
08816-4096
US

V. Phone/Fax

Practice location:
  • Phone: 908-757-9696
  • Fax: 908-757-9721
Mailing address:
  • Phone: 732-390-7750
  • Fax: 732-390-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number25MB05551400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: