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General NPI Number Information
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NPI Number | 1669701264
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Entity Type | Individual
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Provider Name | BRIAN D FANNING JR. MS, ACI, ATC
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Gender | Male
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Dates
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Enumeration Date | 12/11/2009
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 22 WOOD DUCK CT
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City | HACKETTSTOWN
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State | NJ
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Zip | 07840-3312
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Country | US
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Telephone | 973-229-6280
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Fax | 973-353-1431
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Provider Business Mailing Address
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Address Line | 22 WOOD DUCK CT
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City | HACKETTSTOWN
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State | NJ
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Zip | 07840-3312
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Country | US
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Telephone | 973-229-6280
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Fax | 973-353-1431
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00122800
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License Number State | NJ
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