Provider Demographics
NPI:1184767055
Name:BRANDOFF, CRAIG (DPM)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:BRANDOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BROADWAY
Mailing Address - Street 2:SUITE 1638
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1617
Mailing Address - Country:US
Mailing Address - Phone:212-742-0652
Mailing Address - Fax:212-755-7429
Practice Address - Street 1:42 BROADWAY
Practice Address - Street 2:SUITE 1638
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1617
Practice Address - Country:US
Practice Address - Phone:212-742-0652
Practice Address - Fax:212-755-7429
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004210213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT51406Medicare UPIN
NYP44631Medicare ID - Type Unspecified