Provider Demographics
NPI:1023447653
Name:BRAM, JANE EISNER (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:EISNER
Last Name:BRAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E 84TH ST
Mailing Address - Street 2:3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0915
Mailing Address - Country:US
Mailing Address - Phone:212-879-5839
Mailing Address - Fax:212-288-4203
Practice Address - Street 1:124 E 84TH ST
Practice Address - Street 2:3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0915
Practice Address - Country:US
Practice Address - Phone:212-879-5839
Practice Address - Fax:212-288-4203
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR024098-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1023447653Medicare NSC