Provider Demographics
NPI:1306884515
Name:BRENNAN, WILLIAM FREDERICK (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2848 S DELSEA DR
Mailing Address - Street 2:STE 4B
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-7042
Mailing Address - Country:US
Mailing Address - Phone:856-205-7070
Mailing Address - Fax:
Practice Address - Street 1:410 N BROADWAY
Practice Address - Street 2:STE 1
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-1047
Practice Address - Country:US
Practice Address - Phone:856-589-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03184700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC52725Medicare UPIN
NJ163504Medicare PIN