Provider Demographics
NPI:1831410679
Name:BRENNEN, PETER M (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:BRENNEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:825 E GATE BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2124
Mailing Address - Country:US
Mailing Address - Phone:516-804-5200
Mailing Address - Fax:516-240-6540
Practice Address - Street 1:732 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4929
Practice Address - Country:US
Practice Address - Phone:516-822-3911
Practice Address - Fax:516-674-3017
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2019-09-09
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Provider Licenses
StateLicense IDTaxonomies
NY297179207WX0107X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05424039Medicaid
MD150761300Medicaid
TN103I183589Medicare PIN
DCG00600Medicare PIN