Provider Demographics
NPI:1114489119
Name:WENBERG, BRIANA RAE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:RAE
Last Name:WENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 NEW SCOTLAND AVE
Mailing Address - Street 2:DEPT. OF EMERGENCY MEDICINE
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3412
Mailing Address - Country:US
Mailing Address - Phone:518-262-3131
Mailing Address - Fax:518-262-1165
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:DEPT. OF EMERGENCY MEDICINE
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-3131
Practice Address - Fax:518-262-1165
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320542-01207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine