Basic Information
Provider Information
NPI: 1003142183
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRAYMAN
FirstName: MICHAEL
MiddleName: JUSTIN
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 145 CHESTNUT AVE APT 2L
Address2:  
City: JERSEY CITY
State: NJ
PostalCode: 073061397
CountryCode: US
TelephoneNumber: 5179801120
FaxNumber:  
Practice Location
Address1: 340 E 24TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100104019
CountryCode: US
TelephoneNumber: 2125856221
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/26/2009
LastUpdateDate: 10/26/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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