Provider Demographics
NPI:1205125267
Name:BRIGHT, RENAE C (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:RENAE
Middle Name:C
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 E BROADWAY
Mailing Address - Street 2:LONG BEACH #4
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4437
Mailing Address - Country:US
Mailing Address - Phone:516-302-8444
Mailing Address - Fax:
Practice Address - Street 1:461 E BROADWAY
Practice Address - Street 2:LONG BEACH #4
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4437
Practice Address - Country:US
Practice Address - Phone:516-302-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002583-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical