MEDICARE: DR. WILLIAM W BRINER JR. 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	207Q00000X	Family Medicine Physician	036075275	IL
2	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	036075275	IL

General Provider Information

NPI Number	:	1497780886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM W BRINER JR. MD

Provider Business Mailing Address
First Line	:	333 EARLE OVINGTON BLVD
Second Line	:	SUITE 106
City	:	UNIONDALE
State	:	NY
Zip	:	11553-3610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 EARLE OVINGTON BLVD
Second Line	:	SUITE 106
City	:	UNIONDALE
State	:	NY
Zip	:	11553-3610
Country	:	US
Telephone Number	:	516-222-8881
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	01/27/2021

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