Provider Demographics
NPI:1114900321
Name:BRAND, ELLEN J (OD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:J
Last Name:BRAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 ECHO HILL PATH
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-5703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 6TH AVE
Practice Address - Street 2:HERALD SQUARE OPTOMETRIC ASSOCIATES (2ND FLOOR)
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3505
Practice Address - Country:US
Practice Address - Phone:212-967-4177
Practice Address - Fax:212-967-2101
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004261-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC3386Medicare ID - Type UnspecifiedMEDICARE PROVIDER # C3386
NYT49139Medicare UPIN