Provider Demographics
NPI:1780867184
Name:EDGAR G BRAUNSTEIN, MD PA
Entity Type:Organization
Organization Name:EDGAR G BRAUNSTEIN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRAUNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-869-3453
Mailing Address - Street 1:7316 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4035
Mailing Address - Country:US
Mailing Address - Phone:201-869-3253
Mailing Address - Fax:201-869-8934
Practice Address - Street 1:7316 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4035
Practice Address - Country:US
Practice Address - Phone:201-869-3253
Practice Address - Fax:201-869-8934
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDGAR G BRAUNSTEIN, MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA014103207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0827960001Medicare NSC
NJ458407Medicare PIN