MEDICARE: DUSTIN AVERY BRINKER MD

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	2084P0800X	Psychiatry Physician	328269	NY

General Provider Information

NPI Number	:	1356081293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN AVERY BRINKER MD

Provider Business Mailing Address
First Line	:	1111 MARCUS AVE STE M04
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1034
Country	:	US
Telephone Number	:	585-736-3650
Fax Number	:

Provider Business Practice Location Address
First Line	:	75-59 263RD ST
Second Line	:
City	:	GLEN OAKS
State	:	NY
Zip	:	11004
Country	:	US
Telephone Number	:	718-470-8005
Fax Number	:

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

Provider Enumeration Date	:	03/30/2022
Last Update Date	:	06/01/2026

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