MEDICARE: DR. EILEEN ELIZABETH BRENNAN PH.D

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	174400000X	Specialist	000602-1	NY

General Provider Information

NPI Number	:	1326135674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EILEEN ELIZABETH BRENNAN PH.D

Provider Business Mailing Address
First Line	:	26 DE KOVEN CT
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1708
Country	:	US
Telephone Number	:	718-434-2935
Fax Number	:	718-982-2159

Provider Business Practice Location Address
First Line	:	26 DE KOVEN CT
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1708
Country	:	US
Telephone Number	:	718-434-2935
Fax Number	:	718-982-2159

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/21/2022

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