Provider Demographics
NPI:1861679003
Name:BRAVO, J. EDUARDO (AUD)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:EDUARDO
Last Name:BRAVO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:ED
Other - Middle Name:
Other - Last Name:BRAVO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:688 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5059
Mailing Address - Country:US
Mailing Address - Phone:914-472-4444
Mailing Address - Fax:914-931-3485
Practice Address - Street 1:688 WHITE PLAINS RD
Practice Address - Street 2:SUITE 225
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5059
Practice Address - Country:US
Practice Address - Phone:914-472-4444
Practice Address - Fax:914-931-3485
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001303-1237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS18152Medicare UPIN
NYM03873Medicare PIN