Provider Demographics
NPI:1265479539
Name:BRENER, ZACHARY ZINOVY (MD,)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ZINOVY
Last Name:BRENER
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 1:150 E 61ST ST
Mailing Address - Street 2:APT 16B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8529
Mailing Address - Country:US
Mailing Address - Phone:718-648-2161
Mailing Address - Fax:718-645-1148
Practice Address - Street 1:1309 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1164
Practice Address - Country:US
Practice Address - Phone:718-648-2162
Practice Address - Fax:718-645-1148
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217004174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02239605Medicaid
NY02239605Medicaid
H58129Medicare UPIN