Healthcare Provider Details

I. General information

NPI: 1912647470
Provider Name (Legal Business Name): BRENDAN GABRIEL CAMP DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 1ST AVE
NEW YORK NY
10016-6419
US

IV. Provider business mailing address

520 1ST AVE
NEW YORK NY
10016-6419
US

V. Phone/Fax

Practice location:
  • Phone: 212-447-2049
  • Fax:
Mailing address:
  • Phone: 212-447-2049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number1018422
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number340140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: