Provider Demographics
NPI:1871692913
Name:SISON, BRENDA C (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:C
Last Name:SISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:117 HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1823
Mailing Address - Country:US
Mailing Address - Phone:973-322-8074
Mailing Address - Fax:973-322-2856
Practice Address - Street 1:94 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5672
Practice Address - Country:US
Practice Address - Phone:973-322-2800
Practice Address - Fax:973-322-2856
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA0540292080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0568503Medicaid
NJ674930Medicare ID - Type Unspecified
NJ0568503Medicaid