Healthcare Provider Details

I. General information

NPI: 1689820474
Provider Name (Legal Business Name): TIMOTHY KOEHLER BRENNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE FL 8
NEW YORK NY
10019
US

IV. Provider business mailing address

1400 IRVING ST NW #312
WASHINGTON DC
20010-2850
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-8943
  • Fax: 212-523-8057
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number260958
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: