Provider Demographics
NPI:1952624249
Name:HABENICHT-BRAID, BRENDA L (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:L
Last Name:HABENICHT-BRAID
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:L
Other - Last Name:BRAID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11 PRALL RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-8200
Mailing Address - Country:US
Mailing Address - Phone:908-874-0246
Mailing Address - Fax:
Practice Address - Street 1:11 PRALL RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-8200
Practice Address - Country:US
Practice Address - Phone:908-874-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00554000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U00934Medicare UPIN
NJ026951Medicare PIN