Provider Demographics
NPI:1760860415
Name:BRAY, JEFFREY (AT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:BRAY
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2392 WIDOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-9223
Mailing Address - Country:US
Mailing Address - Phone:315-694-0013
Mailing Address - Fax:315-279-5777
Practice Address - Street 1:141 CENTRAL AVE
Practice Address - Street 2:KEUKA COLLEGE
Practice Address - City:KEUKA PARK
Practice Address - State:NY
Practice Address - Zip Code:14478-9764
Practice Address - Country:US
Practice Address - Phone:315-279-5656
Practice Address - Fax:315-279-5777
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000712-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor