Individual provider Active NPI

Marianne Elizabeth Brulhardt, NPP

  • Psychiatric/Mental Health Nurse Practitioner
  • Wantagh, NY
National Provider Identifier
1952726564
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
F401665 Issued in NY
Practice address
58 Tinsel CT
Wantagh, NY 11793-1936
Phone
(631) 383-3689
Fax
(412) 753-7938
NPI assigned
Feb 19, 2014
Last updated
Sep 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X F401665 NY Primary

Addresses

Primary practice location

58 Tinsel CT
Wantagh, NY 11793-1936

Mailing address

58 Tinsel CT
Wantagh, NY 11793-1936
Phone (631) 383-3689

Other practice location 1

25 Melville Park Rd Ste 108
Melville, NY 11747-3174
Phone (631) 204-3434

Other practice location 2

600 Market St
Leesburg, FL 34748-5143
Phone (631) 204-3434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140605000572 NY Practitioner - Nurse Practitioner 6305060757 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F401665NYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Long Beach Reach Inc. CurrentSince Nov 18, 2017 Accepting new patients
Sun River Health Inc Current Accepting new patients
Sun River Health Inc. CurrentSince Oct 7, 2019 Accepting new patients

Locations

3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006

1080 Sunrise Hwy
Amityville, NY 11701
Phone (631) 716-9026

2-12 W Park Ave
Ste 200
Long Beach, NY 11561
Phone (516) 889-2332

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1392768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789516800000",
    "number": "1952726564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 TINSEL CT",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117931936",
            "telephone_number": "631-383-3689",
            "fax_number": "412-753-7938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 TINSEL CT",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117931936",
            "telephone_number": "631-383-3689",
            "fax_number": "412-753-7938"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 Melville Park Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Melville",
            "state": "NY",
            "postal_code": "117473174",
            "country_code": "US",
            "telephone_number": "631-204-3434",
            "fax_number": "412-753-7938",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Market St",
            "address_purpose": "LOCATION",
            "city": "Leesburg",
            "state": "FL",
            "postal_code": "347485143",
            "country_code": "US",
            "telephone_number": "631-204-3434",
            "fax_number": "412-753-7938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRULHARDT",
        "first_name": "MARIANNE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "NPP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-19",
        "last_updated": "2026-09-16",
        "certification_date": "2026-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F401665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wantagh, NY

Sources for this page

Verify at the official NPI Registry.