Provider Demographics
NPI:1225352305
Name:CUNNANE, BRIAN A
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:A
Last Name:CUNNANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 FOUNTAIN AVENUE
Mailing Address - Street 2:BROOKLYN DDSO
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208
Mailing Address - Country:US
Mailing Address - Phone:718-642-6040
Mailing Address - Fax:
Practice Address - Street 1:888 FOUNTAIN AVENUE
Practice Address - Street 2:BROOKLYN DDSO
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208
Practice Address - Country:US
Practice Address - Phone:718-642-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist