Provider Demographics
NPI:1356129191
Name:BRUTUS, MADJEANNA (PA-C)
Entity type:Individual
Prefix:
First Name:MADJEANNA
Middle Name:
Last Name:BRUTUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-3210
Mailing Address - Country:US
Mailing Address - Phone:845-333-6500
Mailing Address - Fax:845-333-6501
Practice Address - Street 1:38 CONCORD RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-3210
Practice Address - Country:US
Practice Address - Phone:845-333-6500
Practice Address - Fax:845-333-6501
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030958363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical