Provider Demographics
NPI:1023005485
Name:BREMILLER, WILLIAM STUART (MS MDT SCMT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:STUART
Last Name:BREMILLER
Suffix:
Gender:M
Credentials:MS MDT SCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:
Practice Address - Street 1:2 FRONT ST
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545
Practice Address - Country:US
Practice Address - Phone:845-677-5021
Practice Address - Fax:845-677-3117
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003455225100000X
NY010882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R76859Medicare UPIN
NYQ65391Medicare ID - Type Unspecified