Provider Demographics
NPI:1760273817
Name:BRISON, JENELLE (MD)
Entity type:Individual
Prefix:DR
First Name:JENELLE
Middle Name:
Last Name:BRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENELLE
Other - Middle Name:
Other - Last Name:BRISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:125 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2303
Mailing Address - Country:US
Mailing Address - Phone:917-975-3174
Mailing Address - Fax:
Practice Address - Street 1:400 LAKEVILLE RD STE 225A
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1121
Practice Address - Country:US
Practice Address - Phone:516-470-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174V00000XOther Service ProvidersClinical Ethicist