Provider Demographics
NPI:1801030606
Name:PHALEN, BRENDON JUSTIN (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:BRENDON
Middle Name:JUSTIN
Last Name:PHALEN
Suffix:
Gender:M
Credentials:MD MBA
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Mailing Address - Street 1:12 E 88TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0539
Mailing Address - Country:US
Mailing Address - Phone:917-848-8255
Mailing Address - Fax:212-920-2499
Practice Address - Street 1:38 GREENE ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2505
Practice Address - Country:US
Practice Address - Phone:212-920-2400
Practice Address - Fax:212-920-2499
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2023-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY243646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine