Provider Demographics
NPI:1467895607
Name:RIEDERS, BRANDON
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:RIEDERS
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 1:210 E SUNRISE HWY STE 304
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1328
Mailing Address - Country:US
Mailing Address - Phone:516-825-8484
Mailing Address - Fax:516-825-8491
Practice Address - Street 1:210 E SUNRISE HWY STE 304
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1328
Practice Address - Country:US
Practice Address - Phone:516-825-8484
Practice Address - Fax:516-825-8491
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296242-01207RG0100X
DC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program