Provider Demographics
NPI:1245234202
Name:BRENNER, STEPHEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:BRENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHRISTIE PL # 407
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-8302
Mailing Address - Country:US
Mailing Address - Phone:914-723-9113
Mailing Address - Fax:718-601-5642
Practice Address - Street 1:1 CHRISTIE PLACE, #407
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-0000
Practice Address - Country:US
Practice Address - Phone:914-723-9113
Practice Address - Fax:718-601-5642
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090574-1207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00187514OtherRAILROAD MEDICARE
NY001434719Medicaid
NY001434719Medicaid
NYP00187514OtherRAILROAD MEDICARE