Provider Demographics
NPI:1841332152
Name:BRAUNSTEIN, KENNETH H (OD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:BRAUNSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SOUTH BROADWAY LOBBY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:917-963-9787
Mailing Address - Fax:914-963-8411
Practice Address - Street 1:20 SOUTH BROADWAY LOBBY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:917-963-9787
Practice Address - Fax:914-963-8411
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0033161152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00469058Medicaid
C96581Medicare ID - Type Unspecified
T81457Medicare UPIN
NY00469058Medicaid