Provider Demographics
NPI:1891876637
Name:BREMER, JAMES M (AUD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:BREMER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2329
Mailing Address - Country:US
Mailing Address - Phone:315-337-0654
Mailing Address - Fax:315-337-0767
Practice Address - Street 1:1300 FLOYD AVE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-4600
Practice Address - Country:US
Practice Address - Phone:315-337-0654
Practice Address - Fax:315-337-0767
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001348231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB5266Medicare PIN
NYJ400034710Medicare PIN