Healthcare Provider Details

I. General information

NPI: 1457533093
Provider Name (Legal Business Name): BRASNER BLUMBERG & AMARU MD LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 PARK AVE
NEW YORK NY
10128-1243
US

IV. Provider business mailing address

1125 PARK AVE
NEW YORK NY
10128-1243
US

V. Phone/Fax

Practice location:
  • Phone: 917-492-9200
  • Fax: 917-492-8129
Mailing address:
  • Phone: 917-492-9200
  • Fax: 917-492-8129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number191295
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number217924
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number216565
License Number StateNY

VIII. Authorized Official

Name: QUIANA SHANTEL MCCOOK
Title or Position: OFFICE MANAGER
Credential:
Phone: 917-492-9200