Provider Demographics
NPI:1699855726
Name:BRAUNSTEIN, HOWARD (OPHTHALIC DISPENSER)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:BRAUNSTEIN
Suffix:
Gender:M
Credentials:OPHTHALIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5415
Mailing Address - Country:US
Mailing Address - Phone:516-561-8545
Mailing Address - Fax:516-561-8545
Practice Address - Street 1:54 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5415
Practice Address - Country:US
Practice Address - Phone:516-561-8545
Practice Address - Fax:516-561-8545
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5112156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01619429Medicaid
NY0870140001Medicare ID - Type Unspecified