Provider Demographics
NPI:1962456814
Name:BRAHMBHATT, SUMANKUMAR S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMANKUMAR
Middle Name:S
Last Name:BRAHMBHATT
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 1:559 ALMENA AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2133
Mailing Address - Country:US
Mailing Address - Phone:914-479-5167
Mailing Address - Fax:914-693-3884
Practice Address - Street 1:640 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2802
Practice Address - Country:US
Practice Address - Phone:718-655-1400
Practice Address - Fax:718-325-4655
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220437208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02196445Medicaid
NYH53069Medicare UPIN
NY02196445Medicaid