Healthcare Provider Details

I. General information

NPI: 1487067948
Provider Name (Legal Business Name): BRANDON MICHAEL VEREMIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL ANNENBERG 15-26
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL ANNENBERG 15-26
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-0705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRES.3440
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number058062
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: