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General NPI Number Information
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NPI Number | 1316174758
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Entity Type | Organization
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Legal Business Name | DANA BRENNER, M.D., P.C.
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BUILDING 20B
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-751-3535
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Fax | 631-751-8766
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Provider Business Mailing Address
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Address Line | 2500 NESCONSET HWY BUILDING 20B
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-751-3535
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Fax | 631-751-8766
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. DANA BRENNER
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Credential | M.D.
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Telephone | 631-751-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 209534
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License Number State | NY
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