Provider Demographics
NPI:1942404017
Name:MCCOY, BRENDA HELEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:HELEN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 GRAND CONCOURSE
Mailing Address - Street 2:# 9C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451
Mailing Address - Country:US
Mailing Address - Phone:718-538-0661
Mailing Address - Fax:
Practice Address - Street 1:1249 5TH AVE
Practice Address - Street 2:TERENCE CARDINAL COOKE HEALTH CARE CENTER
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-360-3957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS149896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01007330Medicaid
NY859091Medicare ID - Type Unspecified
NY01007330Medicaid