Provider Demographics
NPI:1902113392
Name:MICHAEL J. BRUNETTI, D.P.M., P.C.
Entity Type:Organization
Organization Name:MICHAEL J. BRUNETTI, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKINNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-244-9530
Mailing Address - Street 1:423 E 75TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3119
Mailing Address - Country:US
Mailing Address - Phone:212-534-9393
Mailing Address - Fax:212-534-9397
Practice Address - Street 1:305 E 86TH ST
Practice Address - Street 2:SUITE 1GW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4702
Practice Address - Country:US
Practice Address - Phone:212-534-9393
Practice Address - Fax:212-534-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005063-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP60811Medicare PIN
NYU42708Medicare UPIN