Brooke Tenreiro

Individual provider Active NPI Specialist · Yaphank, NY

NPI 1457048811 · NPPES record last updated Apr 18, 2023

Key facts

NPI
1457048811
Entity type
Individual (NPI type 1)
Primary specialty
Specialist 174400000X
License
1682619231 (NY)
Practice address
142 Gerard Rd
Yaphank, NY 11980-9772
Phone
(631) 559-9784
NPI assigned
Apr 18, 2023
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
1682619231NYMDSpecialist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 1682619231 NY Yes

Addresses

Primary practice location

142 Gerard Rd
Yaphank, NY 11980-9772

Mailing address

142 Gerard Rd
Yaphank, NY 11980-9772
Phone (631) 559-9784

Other providers in Yaphank, NY

All providers in Yaphank, NY · Specialist in New York

Sources for this page

Verify at the official NPI Registry.