1114947397 NPI number — OTTIE LABRANCHE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114947397 NPI number — OTTIE LABRANCHE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LABRANCHE

Provider First Name:

OTTIE

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1114947397

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1209 HEMPSTEAD TPKE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FRANKLIN SQUARE

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11010

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

516-352-8300

Provider Business Mailing Address Fax Number:

516-352-8331

Provider First Line Business Practice Location Address:

1209 HEMPSTEAD TPKE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FRANKLIN SQUARE

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11010-1537

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

516-352-8300

Provider Business Practice Location Address Fax Number:

516-352-8331

Provider Enumeration Date:

07/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  220657 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 070806000104 . This is a "FIDELIS CARE NEW YORK" identifier . This identifiers is of the category "OTHER".
• Identifier: 1313374 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 000513130101 . This is a "HEALTHPLUS" identifier . This identifiers is of the category "OTHER".
• Identifier: 11354771 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
• Identifier: WJW871 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 1000021080 . This is a "AFFINITY" identifier . This identifiers is of the category "OTHER".
• Identifier: 82918600 . This is a "HEALTH PROVIDER NETWORK" identifier . This identifiers is of the category "OTHER".
• Identifier: 220657 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 220657B71 . This is a "HEALTHFIRST" identifier . This identifiers is of the category "OTHER".
• Identifier: 0136196 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
• Identifier: P3697767 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 1194785824 . This is a "NPI GROUP" identifier . This identifiers is of the category "OTHER".
• Identifier: 00220657 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 2662836 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 7880841 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".