Provider Demographics
NPI:1780402172
Name:BRAIMAH, BELLY
Entity type:Individual
Prefix:
First Name:BELLY
Middle Name:
Last Name:BRAIMAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 OCEAN AVE APT A45
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-9008
Mailing Address - Country:US
Mailing Address - Phone:917-855-6349
Mailing Address - Fax:
Practice Address - Street 1:1038 OCEAN AVE APT A45
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-9008
Practice Address - Country:US
Practice Address - Phone:917-855-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF406068363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health