Fennelly, Bryan William

Fennelly, Bryan William is an sole proprietor health care provider with primary practice located at 8 Shunpike Rd Suite 9, Madison NJ 07940-2740. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is his primary health care specialty. Fennelly, Bryan William can be contacted via phone (973) 660-0084.

Contact Information

Primary practice address
8 Shunpike Rd Suite 9 Madison NJ 07940-2740
Phone: (973) 660-0084
Fax: (973) 966-0332
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 25MA06022900 New Jersey
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X 25MA06022900 New Jersey

Profile Details

NPI number 1669588406
LBN Legal business name Fennelly, Bryan William
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 22nd, 2006
Last updated Jan 12th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669588406 NPPES
New Jersey MEDICAID 6255809

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