Provider Demographics
NPI:1922341742
Name:BRENNAN, GERALYN (MED)
Entity Type:Individual
Prefix:MRS
First Name:GERALYN
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 W CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1804
Mailing Address - Country:US
Mailing Address - Phone:516-713-3443
Mailing Address - Fax:
Practice Address - Street 1:348 W CHESTER ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1804
Practice Address - Country:US
Practice Address - Phone:516-713-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY763589174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist