MEDICARE: DR. ZACHARY ZINOVY BRENER M.D,

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	174400000X	Specialist	217004	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265479539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACHARY ZINOVY BRENER M.D,

Provider Business Mailing Address
First Line	:	150 E 61ST ST
Second Line	:	APT 16B
City	:	NEW YORK
State	:	NY
Zip	:	10065-8529
Country	:	US
Telephone Number	:	718-648-2161
Fax Number	:	718-645-1148

Provider Business Practice Location Address
First Line	:	1309 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1164
Country	:	US
Telephone Number	:	718-648-2162
Fax Number	:	718-645-1148

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	12/10/2012

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