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General NPI Number Information
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NPI Number | 1821982075
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Entity Type | Individual
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Provider Name | BRENDAN J BERUBE PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 82 NEW PARK AVE
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City | NORTH FRANKLIN
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State | CT
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Zip | 06254-1807
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Country | US
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Telephone | 860-889-7345
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Fax |
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Provider Business Mailing Address
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Address Line | 201 HUME DR
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City | HAMDEN
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State | CT
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Zip | 06514-1635
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Country | US
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Telephone | 203-812-0271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1211327
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 7164
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License Number State | CT
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