Provider Demographics
NPI:1356347314
Name:DELAMERE, BRENDAN DAMIAN (DC)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:DAMIAN
Last Name:DELAMERE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-0758
Mailing Address - Country:US
Mailing Address - Phone:845-628-6000
Mailing Address - Fax:845-621-2225
Practice Address - Street 1:410 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1518
Practice Address - Country:US
Practice Address - Phone:845-628-6000
Practice Address - Fax:845-621-2225
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009453-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX5C601Medicare ID - Type Unspecified
NYU80806Medicare UPIN