Healthcare Provider Details

I. General information

NPI: 1508956863
Provider Name (Legal Business Name): RENEE P BRAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3765 RIVERDALE AVE SUITE 4
BRONX NY
10463-1845
US

IV. Provider business mailing address

3765 RIVERDALE AVE SUITE 4
BRONX NY
10463-1845
US

V. Phone/Fax

Practice location:
  • Phone: 718-548-7300
  • Fax: 718-548-4123
Mailing address:
  • Phone: 718-548-7300
  • Fax: 718-548-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number163789
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: