Provider Demographics
NPI:1700553716
Name:BRAVE, MARTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:BRAVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 W 95TH ST APT 3G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6745
Mailing Address - Country:US
Mailing Address - Phone:201-245-2445
Mailing Address - Fax:
Practice Address - Street 1:70 W 95TH ST APT 3G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6745
Practice Address - Country:US
Practice Address - Phone:201-245-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant