Provider Demographics
NPI:1437518701
Name:DILLANE, BRENDAN
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:DILLANE
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 1:3780 64TH ST
Mailing Address - Street 2:APT #D27
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2766
Mailing Address - Country:US
Mailing Address - Phone:917-485-0504
Mailing Address - Fax:914-390-0212
Practice Address - Street 1:3780 64TH ST
Practice Address - Street 2:APT #D27
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2766
Practice Address - Country:US
Practice Address - Phone:917-485-0504
Practice Address - Fax:914-390-0212
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023522-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist