Provider Demographics
NPI:1730802869
Name:BRENER, DMITRIY (PA-C)
Entity type:Individual
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First Name:DMITRIY
Middle Name:
Last Name:BRENER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:15 ENGLE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2920
Mailing Address - Country:US
Mailing Address - Phone:201-753-8862
Mailing Address - Fax:551-245-8822
Practice Address - Street 1:200 PERRINE RD STE 220
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2836
Practice Address - Country:US
Practice Address - Phone:201-753-8862
Practice Address - Fax:201-408-5278
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00735100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant