Provider Demographics
NPI:1568499978
Name:BRACCO, PHILIP THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:THOMAS
Last Name:BRACCO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6021
Mailing Address - Country:US
Mailing Address - Phone:718-494-9390
Mailing Address - Fax:718-494-0097
Practice Address - Street 1:2 ELWOOD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6021
Practice Address - Country:US
Practice Address - Phone:718-494-9390
Practice Address - Fax:718-494-0097
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003561-0111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX21991Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NYT52638Medicare UPIN