Healthcare Provider Details

I. General information

NPI: 1992291223
Provider Name (Legal Business Name): HANNAH L. BROOKS, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E MAIN ST APT 1
BEACON NY
12508-3389
US

IV. Provider business mailing address

99 E MAIN ST APT 1
BEACON NY
12508-3389
US

V. Phone/Fax

Practice location:
  • Phone: 845-645-9824
  • Fax:
Mailing address:
  • Phone: 845-645-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number184637
License Number StateNY

VIII. Authorized Official

Name: DR. HANNAH L BROOKS
Title or Position: SOLE MEMBER
Credential: MD
Phone: 845-645-9824