Active NPI
Bruce John Brennan
- Registered Dietitian
- Elmira, NY
National Provider Identifier
1669117032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 380322
- Practice address
- 1003 Walnut St
Elmira, NY 14901-1007 - Phone
- (607) 732-5646
- Fax
- (607) 732-0373
- NPI assigned
- May 1, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 380322 | Primary |
Addresses
Primary practice location
1003 Walnut St
Elmira, NY 14901-1007
Mailing address
1003 Walnut St
Elmira, NY 14901-1007
Phone (607) 732-5646
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457010910 | Other | NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651363200000",
"number": "1669117032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1003 WALNUT ST",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149011007",
"telephone_number": "607-732-5646",
"fax_number": "607-732-0373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1003 WALNUT ST",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149011007",
"telephone_number": "607-732-5646",
"fax_number": "607-732-0373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNAN",
"first_name": "BRUCE",
"middle_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-01",
"last_updated": "2022-05-01",
"certification_date": "2022-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": "380322",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1457010910",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Elmira, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.