1134165426 NPI number — JOHN P BRANWELL

Table of content: JOHN P BRANWELL (NPI 1134165426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134165426 NPI number — JOHN P BRANWELL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRANWELL
Provider First Name:
JOHN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRANWELL
Provider Other First Name:
JOHN
Provider Other Middle Name:
PAUL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1134165426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 SEELEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07032-1806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-998-9700
Provider Business Mailing Address Fax Number:
201-998-4899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 SEELEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEARNY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07032-1806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-998-9700
Provider Business Practice Location Address Fax Number:
201-998-4899
Provider Enumeration Date:
06/22/2006

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: 213E00000X , with the licence number:  MD002097 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5553806 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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