Provider Demographics
NPI:1932285772
Name:BRENNAN, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1615 NORTHERN BLVD
Mailing Address - Street 2:STE 403
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3033
Mailing Address - Country:US
Mailing Address - Phone:516-627-0146
Mailing Address - Fax:516-365-4750
Practice Address - Street 1:1615 NORTHERN BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3033
Practice Address - Country:US
Practice Address - Phone:516-627-0146
Practice Address - Fax:516-365-4750
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2017-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY097435207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00164172Medicaid
NYB80011Medicare UPIN
NY958831Medicare ID - Type Unspecified