Provider Demographics
NPI:1154716330
Name:BRENER, ALINA KONNIKOVA (MD)
Entity type:Individual
Prefix:
First Name:ALINA
Middle Name:KONNIKOVA
Last Name:BRENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W 168TH ST # 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3725
Mailing Address - Country:US
Mailing Address - Phone:212-305-9875
Mailing Address - Fax:212-305-9049
Practice Address - Street 1:173 FORT WASHINGTON AVE RM 4-637
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3739
Practice Address - Country:US
Practice Address - Phone:212-305-9875
Practice Address - Fax:212-305-9049
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146224207R00000X, 207RC0200X
390200000X
NY309465207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program