Provider Demographics
NPI:1215978598
Name:BRUSTEIN, DENNIS M (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:BRUSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COUNTRY PL
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1018
Mailing Address - Country:US
Mailing Address - Phone:917-690-5043
Mailing Address - Fax:
Practice Address - Street 1:9876 QUEENS BLVD STE 1K
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4333
Practice Address - Country:US
Practice Address - Phone:718-459-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121070207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01838568Medicaid
NY01838568Medicaid
NY9255BWMedicare PIN