Healthcare Provider Details

I. General information

NPI: 1932323532
Provider Name (Legal Business Name): HILLARY BRUNNER, DPM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155B MINEOLA BLVD STE B
MINEOLA NY
11501-3920
US

IV. Provider business mailing address

2203 COURT NORTH DR
MELVILLE NY
11747-8121
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-3338
  • Fax:
Mailing address:
  • Phone: 917-575-5488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number65 006218
License Number StateNY

VIII. Authorized Official

Name: DR. HILLARY ELIZABETH BRUNNER
Title or Position: PRESIDENT
Credential: D.P.M
Phone: 917-575-5488