Healthcare Provider Details

I. General information

NPI: 1407963424
Provider Name (Legal Business Name): ELISE MICHELE BRETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 PARK AVE
NEW YORK NY
10128-1314
US

IV. Provider business mailing address

1192 PARK AVE
NEW YORK NY
10128-1314
US

V. Phone/Fax

Practice location:
  • Phone: 212-831-2100
  • Fax: 212-831-2137
Mailing address:
  • Phone: 212-831-2100
  • Fax: 212-831-2137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number202084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: