Provider Demographics
NPI:1235198250
Name:BRANOVAN, DANIEL IGOR (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:IGOR
Last Name:BRANOVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:BRANOVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1810 VOORHIES AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3313
Mailing Address - Country:US
Mailing Address - Phone:718-616-1000
Mailing Address - Fax:718-616-1110
Practice Address - Street 1:1810 VOORHIES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3609
Practice Address - Country:US
Practice Address - Phone:718-616-1000
Practice Address - Fax:718-616-1110
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199622208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01817849Medicaid
NYG67829Medicare UPIN
NY04Z781Medicare ID - Type Unspecified