Provider Demographics
NPI:1225085335
Name:BRAHMBHATT, DEVENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVENDRA
Middle Name:
Last Name:BRAHMBHATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 EAST SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581
Mailing Address - Country:US
Mailing Address - Phone:516-568-9119
Mailing Address - Fax:516-568-9485
Practice Address - Street 1:210 E SUNRISE HWY STE 303
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1328
Practice Address - Country:US
Practice Address - Phone:516-568-9119
Practice Address - Fax:516-568-9485
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1810232086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01269350Medicaid
NY97F031Medicare ID - Type Unspecified
NYE94867Medicare UPIN