Provider Demographics
NPI:1558632547
Name:DR. ELLEN BRAUNSTEIN, MD, PC
Entity Type:Organization
Organization Name:DR. ELLEN BRAUNSTEIN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BRAUNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-374-7246
Mailing Address - Street 1:949 CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1204
Mailing Address - Country:US
Mailing Address - Phone:516-374-7246
Mailing Address - Fax:516-374-4408
Practice Address - Street 1:949 CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1204
Practice Address - Country:US
Practice Address - Phone:516-374-7246
Practice Address - Fax:516-374-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157489-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92D821Medicare UPIN