MEDICARE: BRENNER HOLDINGS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1225443328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENNER HOLDINGS INC.

Provider Business Mailing Address
First Line	:	195 WILLOUGHBY AVE
Second Line	:	SUITE 1104
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3843
Country	:	US
Telephone Number	:	718-638-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 WILLOUGHBY AVE
Second Line	:	SUITE 1104
City	:	BROOKLYN
State	:	NY
Zip	:	11205-3843
Country	:	US
Telephone Number	:	718-638-6610
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JOSEPH B MANN
Credential	:	PH.D.
Telephone Number	:	718-638-6610

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	06/20/2018

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