Spine Sports & Rehabilitation Medicine, P.C.

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

Legal business name

SPINE SPORTS & REHABILITATION MEDICINE, P.C.

Practice address

123 Maple Ave Ste LL
Cedarhurst, NY 11516-2240

Phone

(516) 703-3580

Fax

(516) 531-8877

NPI assigned

Nov 16, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michelle Malkie Brunner, MDNPI 1326262064

Title

President

Phone

(516) 987-9837

Specialties & licenses 1

Addresses

Other names 1

• Michelle Malkie Brunner, M.D. Other name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michelle Malkie Brunner, MD

  • Physical Medicine & Rehabilitation Physician
  • Cedarhurst, NY
  • NPI 1326262064
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637020800000",
    "number": "1689330342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "359 YALE AVE",
            "city": "WOODMERE",
            "state": "NY",
            "postal_code": "115982039",
            "telephone_number": "516-987-9837",
            "fax_number": "516-531-8877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 MAPLE AVE STE LL",
            "city": "CEDARHURST",
            "state": "NY",
            "postal_code": "115162240",
            "telephone_number": "516-703-3580",
            "fax_number": "516-531-8877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE SPORTS & REHABILITATION MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-16",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A",
        "authorized_official_last_name": "BRUNNER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "MALKIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-987-9837",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michelle Malkie Brunner, M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Cedarhurst, NY
• Providers in Cedarhurst, NY by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.