Healthcare Provider Details

I. General information

NPI: 1447919600
Provider Name (Legal Business Name): BRIANNA DEUTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIANNA MICHAELS

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

3751 86TH ST APT 3N
JACKSON HEIGHTS NY
11372-7447
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2700
  • Fax:
Mailing address:
  • Phone: 401-829-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number048140-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: