MEDICARE: DR. FREDERICK BRANDT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	MA47807	NJ

General Provider Information

NPI Number	:	1528008737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK BRANDT

Provider Business Mailing Address
First Line	:	600 PAVONIA AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2929
Country	:	US
Telephone Number	:	201-216-3050
Fax Number	:	201-499-0254

Provider Business Practice Location Address
First Line	:	600 PAVONIA AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2929
Country	:	US
Telephone Number	:	201-216-3050
Fax Number	:	201-499-0254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/03/2011

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