Healthcare Provider Details

I. General information

NPI: 1710431101
Provider Name (Legal Business Name): BRANDON HOWARD MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 905
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

415 MYRTLE AVE
FORT LEE NJ
07024-3912
US

V. Phone/Fax

Practice location:
  • Phone: 201-336-0095
  • Fax: 201-820-0817
Mailing address:
  • Phone: 201-336-0095
  • Fax: 201-820-0817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08457400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1821467085
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerNPI

VIII. Authorized Official

Name: DR. BRANDON HOWARD
Title or Position: PHYSICIAN/ OWNER
Credential: MD
Phone: 201-336-0095