Healthcare Provider Details

I. General information

NPI: 1669461638
Provider Name (Legal Business Name): ERIC WILLIAM BREMER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 FRANKLIN AVE SUITE 210
GARDEN CITY NY
11530-5795
US

IV. Provider business mailing address

601 FRANKLIN AVE SUITE 110
GARDEN CITY NY
11530-5795
US

V. Phone/Fax

Practice location:
  • Phone: 516-739-7669
  • Fax: 516-739-7670
Mailing address:
  • Phone: 516-739-7669
  • Fax: 516-739-7670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number048851
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: