=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598973075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEANE BRENNER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 08/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 W 27TH ST RM A402 FASHION INSTITUTE OF TECHNOLOGY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-5902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-217-4190
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13912 87TH AVE
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11435-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-739-7381
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F330844
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------