Provider Demographics
NPI:1083138549
Name:AST, BRENT PAUL (AEMT-CC)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:PAUL
Last Name:AST
Suffix:
Gender:M
Credentials:AEMT-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7195 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9352
Mailing Address - Country:US
Mailing Address - Phone:716-352-0504
Mailing Address - Fax:
Practice Address - Street 1:6763 MINNICK RD LOT 19
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9105
Practice Address - Country:US
Practice Address - Phone:716-352-0504
Practice Address - Fax:716-352-0504
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374087146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic