Provider Demographics
NPI:1316174758
Name:DANA BRENNER, M.D., P.C.
Entity type:Organization
Organization Name:DANA BRENNER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-751-3535
Mailing Address - Street 1:2500 NESCONSET HWY
Mailing Address - Street 2:BUILDING 20B
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2555
Mailing Address - Country:US
Mailing Address - Phone:631-751-3535
Mailing Address - Fax:631-751-8766
Practice Address - Street 1:2500 NESCONSET HWY
Practice Address - Street 2:BUILDING 20B
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:631-751-3535
Practice Address - Fax:631-751-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH24550Medicare UPIN
NY66N781Medicare PIN