Provider Demographics
NPI:1306170402
Name:MINTZ, BRENDA (FNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MINTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:KOSCHITZKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1124
Mailing Address - Country:US
Mailing Address - Phone:917-204-5445
Mailing Address - Fax:516-765-2682
Practice Address - Street 1:3751 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1815
Practice Address - Country:US
Practice Address - Phone:718-362-1411
Practice Address - Fax:718-414-1651
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY543750163W00000X
NYF341692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse