1639181902 NPI number — MR. HUGH BRENNER FPNP, CRNP

Table of content: ALIZA GOLDSMITH MD (NPI 1871157131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639181902 NPI number — MR. HUGH BRENNER FPNP, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRENNER
Provider First Name:
HUGH
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FPNP, CRNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639181902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
186 CAMP COUNCIL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIXVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19460-1990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-896-4466
Provider Business Mailing Address Fax Number:
321-204-6934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
186 CAMP COUNCIL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIXVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19460-1990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-896-4466
Provider Business Practice Location Address Fax Number:
321-204-6934
Provider Enumeration Date:
08/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN287482L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 26NR073233100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: SP011653 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0810X , with the licence number: 26NC07323100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0810X , with the licence number: RN287482L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: SP011653 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8463808 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".