Healthcare Provider Details

I. General information

NPI: 1407974108
Provider Name (Legal Business Name): BRENDA GRACIELA CEAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA MORRIS PA

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4802 10TH AVE
BROOKLYN NY
11219-2916
US

IV. Provider business mailing address

6 MARBLE ST
STATEN ISLAND NY
10314-2132
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-7219
  • Fax:
Mailing address:
  • Phone: 718-749-6530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number006979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: