Individual
DR. BRENT S. INGERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1336 CEDAR ST, ELMIRA, NY 14904-2951
(607) 734-3929
(607) 734-0781
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
232476-1
NY
207Q00000X
Family Medicine Physician
OS012494
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02581455
—
NY
05
—
1012062540001
—
PA
01
—
CC8362
RR MEDICARE GROUP
NY
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039851
MEDICARE GROUP
PA
01
—
P00173974
RR MEDICARE PIN
NY
01
—
P00337166
RR MEDICARE PIN
PA
Enumeration date
03/14/2006
Last updated
03/25/2021
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