Healthcare Provider Details

I. General information

NPI: 1235876830
Provider Name (Legal Business Name): BRENO LERER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HEMPSTEAD TPKE
SOUTH FARMINGDALE NY
11735-2034
US

IV. Provider business mailing address

926 9TH ST # 11704
WEST BABYLON NY
11704-3807
US

V. Phone/Fax

Practice location:
  • Phone: 516-755-5855
  • Fax:
Mailing address:
  • Phone: 631-793-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032557-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: