Provider Demographics
NPI:1770657595
Name:BRAUNSTEIN, MICHAEL CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:BRAUNSTEIN
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 1:1111 BROADHOLLOW RD
Mailing Address - Street 2:STE 205
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4800
Mailing Address - Country:US
Mailing Address - Phone:631-226-6717
Mailing Address - Fax:631-226-6793
Practice Address - Street 1:1111 BROADHOLLOW RD
Practice Address - Street 2:STE 205
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4800
Practice Address - Country:US
Practice Address - Phone:631-226-6717
Practice Address - Fax:631-226-6793
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148696207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00903200Medicaid
NY00903200Medicaid
50D083Medicare ID - Type Unspecified