Provider Demographics
NPI:1902850878
Name:BRENNER, DANA L (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:L
Last Name:BRENNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-331-8777
Mailing Address - Fax:631-474-9169
Practice Address - Street 1:5225 RTE 347 STE 70
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2061
Practice Address - Country:US
Practice Address - Phone:631-331-8777
Practice Address - Fax:631-474-9169
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY209534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH24550Medicare UPIN
NY66N781Medicare ID - Type Unspecified