Provider Demographics
NPI:1689693038
Name:BRILLANTES, ANNE-MARIE BELUANG (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE-MARIE
Middle Name:BELUANG
Last Name:BRILLANTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GLEN BYRON AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4704
Mailing Address - Country:US
Mailing Address - Phone:845-353-1431
Mailing Address - Fax:
Practice Address - Street 1:1150 ST NICHOLAS AVE
Practice Address - Street 2:2ND FL
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10032-3822
Practice Address - Country:US
Practice Address - Phone:212-851-5494
Practice Address - Fax:212-851-5493
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205456-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02385904Medicaid
NY3X3111Medicare ID - Type Unspecified
NY02385904Medicaid