Brenda Jean Connolly, D.O.
Individual provider Active NPI Adult Medicine Physician · Cortland, NY
NPI 1962597310 · NPPES record last updated Aug 2, 2013
Key facts
- NPI
- 1962597310
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Medicine Physician 207QA0505X
- License
- 219374 (NY)
- Practice address
- 4038 West Rd
Cortland, NY 13045-1842 - Phone
- (607) 758-3008
- Fax
- (607) 758-3019
- NPI assigned
- Oct 3, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 219374 | NY | MD | Adult Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Network of Central New York, Inc. | Past | Accepting new patients | |
| Deruyter Health Center | Past | Accepting new patients | |
| Family Health Network of Central New York, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | 219374 | NY | Yes |
Addresses
Primary practice location
4038 West Rd
Cortland, NY 13045-1842
Mailing address
17 Main St
Suite 302
Cortland, NY 13045-6606
Phone (607) 753-3797
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02457596 | Medicaid | NY |
Other providers in Cortland, NY
- Jennifer Lori Collazo
- Combined Chiropractic and Wellness
- Sonya Ann Comins
- Joelle Conant
- Nancy D. Conley
- Kacie Conrad
- Jesse Constantino
- Erin Contento
- Kaylean Contento
- Mary Ellen Converse
All providers in Cortland, NY · Adult Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.