Healthcare Provider Details

I. General information

NPI: 1831410679
Provider Name (Legal Business Name): PETER M BRENNEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 OLD COUNTRY RD
PLAINVIEW NY
11803-4929
US

IV. Provider business mailing address

825 E GATE BLVD STE 111
GARDEN CITY NY
11530-2124
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-3911
  • Fax: 516-674-3017
Mailing address:
  • Phone: 516-804-5200
  • Fax: 516-240-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number297179
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: