Healthcare Provider Details

I. General information

NPI: 1639178890
Provider Name (Legal Business Name): DR. SIDNEY BRENNER ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 KNORR ST
PHILADELPHIA PA
19149-2307
US

IV. Provider business mailing address

2175 KNORR ST
PHILADELPHIA PA
19149-2307
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-2491
  • Fax: 215-624-4259
Mailing address:
  • Phone: 215-624-2491
  • Fax: 215-624-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. RICHARD PAUL BRENNER
Title or Position: PARTNER
Credential: DO
Phone: 215-624-2491