Provider Demographics
NPI:1235876830
Name:LERER, BRENO
Entity Type:Individual
Prefix:
First Name:BRENO
Middle Name:
Last Name:LERER
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 1:926 9TH ST # 11704
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3807
Mailing Address - Country:US
Mailing Address - Phone:631-793-0450
Mailing Address - Fax:
Practice Address - Street 1:34 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:SOUTH FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2034
Practice Address - Country:US
Practice Address - Phone:516-755-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032557-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist