Healthcare Provider Details

I. General information

NPI: 1871692913
Provider Name (Legal Business Name): BRENDA C. SISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

117 HEMLOCK RD
SHORT HILLS NJ
07078-1823
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-2800
  • Fax: 973-322-2856
Mailing address:
  • Phone: 973-322-8074
  • Fax: 973-322-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMA054029
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: