Healthcare Provider Details

I. General information

NPI: 1780881581
Provider Name (Legal Business Name): BRIAN RUSSELL NERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 FRONT ST
EAST MEADOW NY
11554-2265
US

IV. Provider business mailing address

2800 MARCUS AVE
NEW HYDE PARK NY
11042-1008
US

V. Phone/Fax

Practice location:
  • Phone: 516-758-8670
  • Fax:
Mailing address:
  • Phone: 516-622-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA100309
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number233627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: