Basic Information
| Provider Information | |||||||||
| NPI: | 1063594943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASSIDY | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 416457 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022416457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 2253 SOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | SCOTCH PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070764688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083787200 | ||||||||
| FaxNumber: | 9083787202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA05192100 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.