Healthcare Provider Details

I. General information

NPI: 1497837181
Provider Name (Legal Business Name): BRENDAN GERARD O'CONNOR DDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17411 HORACE HARDING EXPY
FRESH MEADOWS NY
11365-1527
US

IV. Provider business mailing address

345 E 24TH ST 213 SCHWARTZ BLDG.,
NEW YORK NY
10010-4020
US

V. Phone/Fax

Practice location:
  • Phone: 718-640-6498
  • Fax:
Mailing address:
  • Phone: 212-998-9329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number051592-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: