Provider Demographics
NPI:1811317688
Name:BRAVERMAN, CHARLES (MAC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:BRAVERMAN
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NORTHERN BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1000
Mailing Address - Country:US
Mailing Address - Phone:518-482-4898
Mailing Address - Fax:518-463-3020
Practice Address - Street 1:350 NORTHERN BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1000
Practice Address - Country:US
Practice Address - Phone:518-482-4898
Practice Address - Fax:518-463-3020
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY-001560-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTID: 27-1245456OtherNYS