Provider Demographics
NPI:1811062631
Name:ROONEY, BRENDAN P (CO)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:P
Last Name:ROONEY
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 MAIN ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1350
Mailing Address - Country:US
Mailing Address - Phone:845-255-2929
Mailing Address - Fax:845-255-7405
Practice Address - Street 1:243 MAIN ST
Practice Address - Street 2:SUITE 260
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1350
Practice Address - Country:US
Practice Address - Phone:845-255-2929
Practice Address - Fax:845-255-7405
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02119666Medicaid
NY02119666Medicaid