Healthcare Provider Details

I. General information

NPI: 1447888078
Provider Name (Legal Business Name): BRETT RONALD KINGSBOROUGH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
MC GUIRE AFB NJ
08641-5312
US

IV. Provider business mailing address

3458 NEELY RD
MC GUIRE AFB NJ
08641-5312
US

V. Phone/Fax

Practice location:
  • Phone: 866-377-2778
  • Fax: 609-754-9249
Mailing address:
  • Phone: 866-377-2778
  • Fax: 609-754-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0102207086
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: