Dmitriy Brener, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00735100 Issued in NJ

Practice address

200 Perrine Rd Ste 220
Old Bridge, NJ 08857-2836

Phone

(201) 753-8862

Fax

(201) 408-5278

NPI assigned

Sep 23, 2022

Last updated

Sep 23, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: xlz9003@direct.nyp.org

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

{
    "created_epoch": "1663891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1730802869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 ENGLE ST STE 102",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076312920",
            "telephone_number": "201-753-8862",
            "fax_number": "551-245-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PERRINE RD STE 220",
            "city": "OLD BRIDGE",
            "state": "NJ",
            "postal_code": "088572836",
            "telephone_number": "201-753-8862",
            "fax_number": "201-408-5278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENER",
        "first_name": "DMITRIY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-23",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00735100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dbrener@landaspine.com",
            "affiliation": "N",
            "address_1": "200 Perrine Rd Ste 220",
            "city": "Old Bridge",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "088572836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Physician Assistant in Old Bridge, NJ
• Providers in Old Bridge, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.

Verify at the official NPI Registry.