Active NPI
Brian D Fanning Jr., MS, ACI, ATC
- Athletic Trainer
- Hackettstown, NJ
National Provider Identifier
1669701264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 25MT00122800
- Practice address
- 22 Wood Duck CT
Hackettstown, NJ 07840-3312 - Phone
- (973) 229-6280
- Fax
- (973) 353-1431
- NPI assigned
- Dec 11, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 25MT00122800 | NJ | Primary |
Addresses
Primary practice location
22 Wood Duck CT
Hackettstown, NJ 07840-3312
Mailing address
22 Wood Duck CT
Hackettstown, NJ 07840-3312
Phone (973) 229-6280
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MT00122800 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260489600000",
"number": "1669701264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 WOOD DUCK CT",
"city": "HACKETTSTOWN",
"state": "NJ",
"postal_code": "078403312",
"telephone_number": "973-229-6280",
"fax_number": "973-353-1431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 WOOD DUCK CT",
"city": "HACKETTSTOWN",
"state": "NJ",
"postal_code": "078403312",
"telephone_number": "973-229-6280",
"fax_number": "973-353-1431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANNING",
"first_name": "BRIAN",
"middle_name": "D",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "MS, ACI, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-11",
"last_updated": "2009-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "25MT00122800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hackettstown, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.