Healthcare Provider Details

I. General information

NPI: 1437870995
Provider Name (Legal Business Name): BRANDON JAY REXFORD NNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE STE 9100
SYRACUSE NY
13210-1602
US

IV. Provider business mailing address

8 KNIGHTS CIR
BALDWINSVILLE NY
13027-8256
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number350554
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: