Healthcare Provider Details

I. General information

NPI: 1548231814
Provider Name (Legal Business Name): JOHN ARTHUR BRANDEISKY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4249 US HIGHWAY 9 FREEHOLD OFFICE PLAZA
FREEHOLD NJ
07728-8308
US

IV. Provider business mailing address

4249 US HIGHWAY 9 FREEHOLD OFFICE PLAZA
FREEHOLD NJ
07728-8308
US

V. Phone/Fax

Practice location:
  • Phone: 732-308-1090
  • Fax: 732-308-1143
Mailing address:
  • Phone: 732-308-1090
  • Fax: 732-308-1143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00169400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00169400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number25MD00169400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00169400
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00169400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: