Provider Demographics
NPI:1952190084
Name:RAHE, BRENNDAN MICHAEL
Entity type:Individual
Prefix:
First Name:BRENNDAN
Middle Name:MICHAEL
Last Name:RAHE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WEAVER DR APT 4B
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5660
Mailing Address - Country:US
Mailing Address - Phone:914-482-5829
Mailing Address - Fax:
Practice Address - Street 1:80 WEAVER DR APT 4B
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5660
Practice Address - Country:US
Practice Address - Phone:914-482-5829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse