Healthcare Provider Details

I. General information

NPI: 1306884515
Provider Name (Legal Business Name): WILLIAM FREDERICK BRENNAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N BROADWAY STE 1
PITMAN NJ
08071-1047
US

IV. Provider business mailing address

2848 S DELSEA DR STE 4B
VINELAND NJ
08360-7042
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-3708
  • Fax:
Mailing address:
  • Phone: 856-205-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB03184700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: