MEDICARE: EMMANUEL BRUNOT MD PHYSICIAN

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	208000000X	Pediatrics Physician	NYLIC#193810	NY
2	2084N0400X	Neurology Physician	NYLIC#193810	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295896223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL BRUNOT MD PHYSICIAN

Provider Business Mailing Address
First Line	:	10 ASH DRIVE
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576
Country	:	US
Telephone Number	:	516-629-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	5520 GLENWOOD ROAD
Second Line	:	SUITE 3B
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-531-5807
Fax Number	:	718-251-1332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	09/11/2025

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