Provider Demographics
NPI:1568440931
Name:BRAIMAN, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:BRAIMAN
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 1:106 W UTICA STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2525
Mailing Address - Country:US
Mailing Address - Phone:315-343-4436
Mailing Address - Fax:315-343-4437
Practice Address - Street 1:106 W UTICA ST
Practice Address - Street 2:SUITE A
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3059
Practice Address - Country:US
Practice Address - Phone:315-343-4436
Practice Address - Fax:315-343-4437
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2166222084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02072113Medicaid
NYBA0130Medicare ID - Type Unspecified
NYG09265Medicare UPIN
NY02072113Medicaid