Provider Demographics
NPI:1336157940
Name:BRANCH MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BRANCH MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIOTROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-724-2000
Mailing Address - Street 1:267 E MAIN ST
Mailing Address - Street 2:BUILDING A
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2874
Mailing Address - Country:US
Mailing Address - Phone:631-724-2000
Mailing Address - Fax:631-724-3967
Practice Address - Street 1:267 E MAIN ST
Practice Address - Street 2:BUILDING A
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2874
Practice Address - Country:US
Practice Address - Phone:631-724-2000
Practice Address - Fax:631-724-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00696259Medicaid
NYW04911Medicare ID - Type Unspecified