MEDICARE: GRANT H BRENNER M.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	2084P0800X	Psychiatry Physician	212825	NY

General Provider Information

NPI Number	:	1881711612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT H BRENNER M.D.

Provider Business Mailing Address
First Line	:	39 W. 14TH ST.
Second Line	:	SUITE 506
City	:	NEW YORK
State	:	NY
Zip	:	10011-7489
Country	:	US
Telephone Number	:	212-673-2099
Fax Number	:

Provider Business Practice Location Address
First Line	:	841 BROADWAY
Second Line	:	STE. 302
City	:	NEW YORK
State	:	NY
Zip	:	10003-4704
Country	:	US
Telephone Number	:	212-673-2099
Fax Number	:

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

Provider Enumeration Date	:	03/25/2007
Last Update Date	:	06/12/2012

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