Provider Demographics
NPI:1457597841
Name:STEVEN W. BRAUNSTEIN MD
Entity Type:Organization
Organization Name:STEVEN W. BRAUNSTEIN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRAUNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-264-0779
Mailing Address - Street 1:7316 KENNEDY BLVD
Mailing Address - Street 2:PO BOX 7266
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4035
Mailing Address - Country:US
Mailing Address - Phone:201-264-0779
Mailing Address - Fax:201-869-8934
Practice Address - Street 1:7316 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4035
Practice Address - Country:US
Practice Address - Phone:201-264-0779
Practice Address - Fax:201-869-8934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ43329207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1650301Medicaid
512062Medicare PIN
NJ1650301Medicaid