Healthcare Provider Details

I. General information

NPI: 1619354842
Provider Name (Legal Business Name): BRENNA CLAIRE MCCABE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 OLD SHORT HILLS RD
WEST ORANGE NJ
07052-1008
US

IV. Provider business mailing address

95 OLD SHORT HILLS RD
WEST ORANGE NJ
07052-1008
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-4334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MA13041200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD046141
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number317851-01
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMT218589
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: