# JACK L BRENNER MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417268046
- **Authorized official:** DR. JACK L BRENNER M.D. (MEDICAL DOCTOR)
- **Authorized official phone:** (914) 962-5596

## Contact information

- **Practice address:** 1974 MAPLE HILL ST, SUITE 6, YORKTOWN HTS, NY 10598-4190
- **Practice address phone:** (914) 962-5596
- **Practice address fax:** (914) 962-5919
- **Mailing address:** 1974 MAPLE HILL ST, SUITE 6, YORKTOWN HTS, NY 10598-4190
- **Mailing address phone:** (914) 962-5596
- **Mailing address fax:** (914) 962-5919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 1064781 | NY | — |
| 207RG0100X | Gastroenterology Physician | 1064781 | NY | Yes |

## Other

- **Enumeration date:** 06/29/2010
- **Last updated:** 01/10/2018