Provider Demographics
NPI:1891710885
Name:BRENNER, ARNOLD I (DO)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:I
Last Name:BRENNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30749
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-0749
Mailing Address - Country:US
Mailing Address - Phone:718-947-7000
Mailing Address - Fax:718-420-6491
Practice Address - Street 1:475 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-9175
Practice Address - Fax:718-226-8198
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1325482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9N2231Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
NYD90489Medicare UPIN