Provider Demographics
NPI:1326302829
Name:BRISKI, BRENNA C (MA EC/ECSE)
Entity Type:Individual
Prefix:MISS
First Name:BRENNA
Middle Name:C
Last Name:BRISKI
Suffix:
Gender:F
Credentials:MA EC/ECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CABRINI BLVD
Mailing Address - Street 2:8D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3612
Mailing Address - Country:US
Mailing Address - Phone:315-373-7776
Mailing Address - Fax:
Practice Address - Street 1:255 CABRINI BLVD
Practice Address - Street 2:8D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3612
Practice Address - Country:US
Practice Address - Phone:315-373-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY548621111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist