Healthcare Provider Details

I. General information

NPI: 1487573275
Provider Name (Legal Business Name): JOHN COLLINS BREMER HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 FLOYD AVE
ROME NY
13440-4624
US

IV. Provider business mailing address

1300 FLOYD AVE
ROME NY
13440-4624
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-0654
  • Fax: 315-337-0767
Mailing address:
  • Phone: 315-527-1575
  • Fax: 315-337-0767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000085417
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: