Provider Demographics
NPI:1285067470
Name:KIRK, BRENDAN J (DPT)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:J
Last Name:KIRK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BROOK HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2258
Mailing Address - Country:US
Mailing Address - Phone:201-230-2357
Mailing Address - Fax:
Practice Address - Street 1:5 BROOK HOLLOW CT
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-2258
Practice Address - Country:US
Practice Address - Phone:201-230-2357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1005685Medicaid