Provider Demographics
NPI:1003925686
Name:WILLIAM C. BRENDER MD, PC
Entity Type:Organization
Organization Name:WILLIAM C. BRENDER MD, PC
Other - Org Name:ADIRONDACK PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-793-1338
Mailing Address - Street 1:115 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3630
Mailing Address - Country:US
Mailing Address - Phone:518-793-1338
Mailing Address - Fax:518-798-5924
Practice Address - Street 1:115 MAPLE ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3630
Practice Address - Country:US
Practice Address - Phone:518-793-1338
Practice Address - Fax:518-798-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149722-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty