1881889475 NPI number — LAURENCE H BRENNER MD PA

Table of content: (NPI 1881889475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881889475 NPI number — LAURENCE H BRENNER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAURENCE H BRENNER MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HAND SURGERY CENTER OF NORTH ORLANDO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881889475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
687 DOUGLAS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-2515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-339-4263
Provider Business Mailing Address Fax Number:
407-339-4267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
687 DOUGLAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32714-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-339-4263
Provider Business Practice Location Address Fax Number:
407-339-4267
Provider Enumeration Date:
09/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREED
Authorized Official First Name:
DOLORES
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
407-339-4263

Provider Taxonomy Codes

  • Taxonomy code: 2082S0105X , with the licence number:  ME91864 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 274526700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52154A . This is a "MEDICARE INDIVIDUAL PROV#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1306894753 . This is a "INDIVIDUAL PROVIDER NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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