Provider Demographics
NPI:1154605152
Name:DARA BRENER, M.D., P.C.
Entity type:Organization
Organization Name:DARA BRENER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D., CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DARA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:BRENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-680-1142
Mailing Address - Street 1:701 ROUTE 25A
Mailing Address - Street 2:SUITE B1
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2050
Mailing Address - Country:US
Mailing Address - Phone:631-331-4403
Mailing Address - Fax:631-331-1932
Practice Address - Street 1:701 ROUTE 25A
Practice Address - Street 2:SUITE B1
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2050
Practice Address - Country:US
Practice Address - Phone:631-331-4403
Practice Address - Fax:631-331-1932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-09
Last Update Date:2011-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY236587OtherLICENSE