Provider Demographics
NPI:1740371137
Name:BRANDY, CHRISTOPHER F (MDPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:F
Last Name:BRANDY
Suffix:
Gender:M
Credentials:MDPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669
Mailing Address - Country:US
Mailing Address - Phone:315-393-2611
Mailing Address - Fax:315-393-2633
Practice Address - Street 1:305 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669
Practice Address - Country:US
Practice Address - Phone:315-393-2611
Practice Address - Fax:315-393-2633
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131350174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01568932Medicaid
NY01568932Medicaid
NYB96333Medicare UPIN