Provider Demographics
NPI:1447573332
Name:BRAISTED, JEFFREY A (ASRT,R)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:BRAISTED
Suffix:
Gender:M
Credentials:ASRT,R
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Mailing Address - Street 1:384 CRYSTAL RUN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4013
Mailing Address - Country:US
Mailing Address - Phone:845-692-8780
Mailing Address - Fax:845-692-3439
Practice Address - Street 1:384 CRYSTAL RUN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4013
Practice Address - Country:US
Practice Address - Phone:845-692-8780
Practice Address - Fax:845-692-3439
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY4658802471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography