Provider Demographics
NPI:1932282407
Name:BRENNER, LOIS MARGARET (PA-C)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:MARGARET
Last Name:BRENNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 E 86TH ST
Mailing Address - Street 2:1230
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0506
Mailing Address - Country:US
Mailing Address - Phone:212-734-1551
Mailing Address - Fax:
Practice Address - Street 1:83 EAST AVENUE
Practice Address - Street 2:302
Practice Address - City:NORWAK
Practice Address - State:CT
Practice Address - Zip Code:06857
Practice Address - Country:US
Practice Address - Phone:203-853-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011227-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical