Healthcare Provider Details

I. General information

NPI: 1659443901
Provider Name (Legal Business Name): GARRY RICHARD DBRANT DC ND LCSW DA CBN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 GLEN COVE AVE
GLEN HEAD NY
11545
US

IV. Provider business mailing address

10 CEDAR SWAMP RD STE 3
GLEN COVE NY
11542-3746
US

V. Phone/Fax

Practice location:
  • Phone: 516-609-0890
  • Fax: 516-609-0893
Mailing address:
  • Phone: 516-609-0890
  • Fax: 516-609-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR020706
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0207061
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number0037641
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0037641
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0055941
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: