Healthcare Provider Details

I. General information

NPI: 1356081293
Provider Name (Legal Business Name): DUSTIN AVERY BRINKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-59 263RD ST
GLEN OAKS NY
11004
US

IV. Provider business mailing address

1111 MARCUS AVE STE M04
NEW HYDE PARK NY
11042-1034
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-8005
  • Fax:
Mailing address:
  • Phone: 585-736-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number328269
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: