Provider Demographics
NPI:1376760207
Name:BRENOWITZ, KEVIN S (NP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:BRENOWITZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 DENKER PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6164
Mailing Address - Country:US
Mailing Address - Phone:718-494-3367
Mailing Address - Fax:
Practice Address - Street 1:65 CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3944
Practice Address - Country:US
Practice Address - Phone:718-667-8100
Practice Address - Fax:718-667-6280
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335008-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily