Individual
DR. JACK LEON BRENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1974 MAPLE HILL STREET, SUITE 6, YORKTOWN HEIGHTS, NY 10598
(914) 962-5596
(914) 962-5919
Mailing address
1974 MAPLE HILL ST, SUITE 6, YORKTOWN HEIGHTS, NY 10598-4190
(914) 962-5596
(914) 962-5919
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
106478
NY
207RG0100X
Gastroenterology Physician
Primary
106478
NY
Other
Enumeration date
12/04/2006
Last updated
09/19/2012
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