Healthcare Provider Details

I. General information

NPI: 1326262064
Provider Name (Legal Business Name): MICHELLE MALKIE BRUNNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MAPLE AVE LOWR LEVEL
CEDARHURST NY
11516-2240
US

IV. Provider business mailing address

359 YALE AVE
WOODMERE NY
11598-2039
US

V. Phone/Fax

Practice location:
  • Phone: 516-703-3580
  • Fax: 516-531-8877
Mailing address:
  • Phone: 516-703-3580
  • Fax: 516-531-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number223421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: