Provider Demographics
NPI:1245521707
Name:BERRY, BRENDAN ANTHONY (RPA-C)
Entity type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:ANTHONY
Last Name:BERRY
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24428 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1616
Mailing Address - Country:US
Mailing Address - Phone:718-343-8694
Mailing Address - Fax:
Practice Address - Street 1:24428 85TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1616
Practice Address - Country:US
Practice Address - Phone:718-343-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014695-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant