MEDICARE: DR. MARC ALAN BRENNER D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N002371-1	NY

General Provider Information

NPI Number	:	1093899734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC ALAN BRENNER D.P.M.

Provider Business Mailing Address
First Line	:	7309 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7431
Country	:	US
Telephone Number	:	718-456-7270
Fax Number	:	718-456-1874

Provider Business Practice Location Address
First Line	:	7309 MYRTLE AVE
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7431
Country	:	US
Telephone Number	:	718-456-7270
Fax Number	:	718-456-1874

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	01/13/2012

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