Provider Demographics
NPI:1942374103
Name:BRAGIN, TODD JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:JONATHAN
Last Name:BRAGIN
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 1:243 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3243
Mailing Address - Country:US
Mailing Address - Phone:516-887-2020
Mailing Address - Fax:516-887-2073
Practice Address - Street 1:243 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3243
Practice Address - Country:US
Practice Address - Phone:516-887-2020
Practice Address - Fax:516-887-2073
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153285207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B15564Medicare UPIN
53F071Medicare ID - Type Unspecified