1225490477 NPI number — DR. LAWRENCE FRANKLIN BRALY MD

Table of content: DR. LAWRENCE FRANKLIN BRALY MD (NPI 1225490477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225490477 NPI number — DR. LAWRENCE FRANKLIN BRALY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRALY
Provider First Name:
LAWRENCE
Provider Middle Name:
FRANKLIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRALY
Provider Other First Name:
L
Provider Other Middle Name:
FRANKLIN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225490477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 HORATIO ST
Provider Second Line Business Mailing Address:
310
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10014-1574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-255-7801
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 HORATIO ST
Provider Second Line Business Practice Location Address:
310
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10014-1574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-255-7801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  145811 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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