=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124184429
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDNA ANNE PYTLAK, MD & BRIANNE O'CONNOR, MD, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 MONROE PL
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-834-1007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 MONROE PL
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-834-1007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. BRIANNE O'CONNOR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-834-1007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------