Provider Demographics
NPI:1861655896
Name:NOSKO, BRYNNE KATHLEEN (PA)
Entity Type:Individual
Prefix:MRS
First Name:BRYNNE
Middle Name:KATHLEEN
Last Name:NOSKO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:BRYNNE
Other - Middle Name:KATHLEEN
Other - Last Name:RUDMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5586 LEGIONNAIRE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-3504
Mailing Address - Country:US
Mailing Address - Phone:315-699-2837
Mailing Address - Fax:315-752-9506
Practice Address - Street 1:5586 LEGIONNAIRE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-3504
Practice Address - Country:US
Practice Address - Phone:315-699-2837
Practice Address - Fax:315-752-9506
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400038893Medicare PIN
NY1861655896Medicare UPIN
NYJ400004697Medicare PIN
NY03298928Medicaid