Provider Demographics
NPI:1497752935
Name:BRAL, PEDRAM (MD)
Entity Type:Individual
Prefix:
First Name:PEDRAM
Middle Name:
Last Name:BRAL
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 1:7001 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6117
Mailing Address - Country:US
Mailing Address - Phone:718-444-2300
Mailing Address - Fax:718-209-8390
Practice Address - Street 1:7001 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6117
Practice Address - Country:US
Practice Address - Phone:718-444-2300
Practice Address - Fax:718-209-8390
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206153-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01957799Medicaid
NYG99935Medicare UPIN
NY512771Medicare ID - Type Unspecified