Provider Demographics
NPI:1093842700
Name:BRANDMAN, EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:BRANDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SELMA CT
Mailing Address - Street 2:
Mailing Address - City:E NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-6107
Mailing Address - Country:US
Mailing Address - Phone:631-499-5909
Mailing Address - Fax:
Practice Address - Street 1:6 SELMA CT
Practice Address - Street 2:
Practice Address - City:E NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-6107
Practice Address - Country:US
Practice Address - Phone:631-499-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005252103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146278OtherVALUE OPTIONS
NYV24961Medicare ID - Type UnspecifiedPSYCHOLOGIST