Provider Demographics
NPI:1700997848
Name:MICHAEL J. BRENNAN, M.D. LLC
Entity type:Organization
Organization Name:MICHAEL J. BRENNAN, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-255-3451
Mailing Address - Street 1:140 SHERMAN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5849
Mailing Address - Country:US
Mailing Address - Phone:203-255-3451
Mailing Address - Fax:203-255-7478
Practice Address - Street 1:140 SHERMAN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5849
Practice Address - Country:US
Practice Address - Phone:203-255-3451
Practice Address - Fax:203-255-7478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02595Medicare PIN