MEDICARE: DR. ERIC WILLIAM BREMER D.D.S.

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	1223E0200X	Endodontics	048851	NY

General Provider Information

NPI Number	:	1669461638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC WILLIAM BREMER D.D.S.

Provider Business Mailing Address
First Line	:	601 FRANKLIN AVE
Second Line	:	SUITE 110
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5795
Country	:	US
Telephone Number	:	516-739-7669
Fax Number	:	516-739-7670

Provider Business Practice Location Address
First Line	:	601 FRANKLIN AVE
Second Line	:	SUITE 210
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-5795
Country	:	US
Telephone Number	:	516-739-7669
Fax Number	:	516-739-7670

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	03/19/2008

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