Healthcare Provider Details

I. General information

NPI: 1124938709
Provider Name (Legal Business Name): BRENNAN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4752 44TH ST APT B8
WOODSIDE NY
11377-6338
US

IV. Provider business mailing address

530 E 20TH ST APT 3A
NEW YORK NY
10009-1342
US

V. Phone/Fax

Practice location:
  • Phone: 804-317-9969
  • Fax:
Mailing address:
  • Phone: 804-317-9969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANNE B BRENNAN
Title or Position: OWNER
Credential: NP
Phone: 804-317-9969