Provider Demographics
NPI:1518932276
Name:MCKENNA, BRIAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:MCKENNA
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 1:3001 EXPRESSWAY DR N
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5301
Mailing Address - Country:US
Mailing Address - Phone:631-292-6747
Mailing Address - Fax:631-292-6767
Practice Address - Street 1:3001 EXPRESSWAY DR N
Practice Address - Street 2:SUITE 116
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5301
Practice Address - Country:US
Practice Address - Phone:631-292-6747
Practice Address - Fax:631-292-6767
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181486174400000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01344825Medicaid
NY181486OtherHIP
NY3C1748OtherHEALTHNET PHS
NY0203186OtherGHI
NY160054763OtherRAILROAD MEDICARE
NY4256082OtherAETNA
NYCP281OtherOXFORD
NY1226509OtherUNITED HEALTHCARE
NY181486A28OtherHEALTHFIRST
NY466E91OtherBLUE CROSS BLUE SHIELD
NY9605709002OtherCIGNA
NYP43029594OtherMULTIPLAN
NYP43029594OtherMULTIPLAN
NYCP281OtherOXFORD