Healthcare Provider Details

I. General information

NPI: 1053014399
Provider Name (Legal Business Name): BRENDAN DAVID ROSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE GUSTAVE L. LEVY PLACE
NEW YORK NY
10029
US

IV. Provider business mailing address

ONE GUSTAVE L. LEVY PLACE, PO BOX 1230
NEW YORK NY
10029
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number331154-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: