Provider Demographics
NPI:1962579128
Name:BRENNAN, MICHELE M (RD,CDE)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD,CDE
Mailing Address - Street 1:310 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1626
Mailing Address - Country:US
Mailing Address - Phone:732-669-0764
Mailing Address - Fax:
Practice Address - Street 1:385 TREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1023
Practice Address - Country:US
Practice Address - Phone:973-676-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ09810244133NN1002X
NJ817201133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered