Healthcare Provider Details

I. General information

NPI: 1922084441
Provider Name (Legal Business Name): NOOSHIN KETABCHI BRINSTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 WESTCHESTER AVE STE 331
WHITE PLAINS NY
10604-3516
US

IV. Provider business mailing address

1133 WESTCHESTER AVE STE 331
WHITE PLAINS NY
10604-3516
US

V. Phone/Fax

Practice location:
  • Phone: 800-942-3376
  • Fax: 914-996-1525
Mailing address:
  • Phone: 800-942-3376
  • Fax: 914-996-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number216498
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number2126279
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number0101239978
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number216498
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: