Healthcare Provider Details

I. General information

NPI: 1821445552
Provider Name (Legal Business Name): LIRON HEN BRENNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WASHINGTON ST
TENAFLY NJ
07670-3216
US

IV. Provider business mailing address

75 SUSAN DR
CLOSTER NJ
07624-2314
US

V. Phone/Fax

Practice location:
  • Phone: 646-322-2429
  • Fax:
Mailing address:
  • Phone: 646-322-2429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00117800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: