Provider Demographics
NPI:1164708970
Name:BRANIN, IVY NICOL (ND)
Entity Type:Individual
Prefix:DR
First Name:IVY
Middle Name:NICOL
Last Name:BRANIN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2510
Mailing Address - Country:US
Mailing Address - Phone:732-642-2158
Mailing Address - Fax:
Practice Address - Street 1:505 HAMILTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:US
Practice Address - Phone:646-470-8458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0990080970175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0990080970OtherNATUROPATHIC PHYSICIAN LICENSE