Healthcare Provider Details

I. General information

NPI: 1134236888
Provider Name (Legal Business Name): DEBRA J BRENNESSEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

5 BIRCHELL LN
GLEN HEAD NY
11545-2214
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-4847
  • Fax: 718-883-6197
Mailing address:
  • Phone: 516-674-3218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number144468
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number144468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: