Provider Demographics
NPI:1528186483
Name:BRAVERMAN, ERIC RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RANDALL
Last Name:BRAVERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:400 CHAMBERS ST
Mailing Address - Street 2:17K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-1003
Mailing Address - Country:US
Mailing Address - Phone:212-213-6155
Mailing Address - Fax:212-684-0692
Practice Address - Street 1:304 PARK AVE S
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4301
Practice Address - Country:US
Practice Address - Phone:212-213-6155
Practice Address - Fax:212-529-6129
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY159238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY159238OtherLICENSE