1386644987 NPI number — BRAUNAGEL & BRAUNAGEL, INC.

Table of content: (NPI 1386644987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386644987 NPI number — BRAUNAGEL & BRAUNAGEL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAUNAGEL & BRAUNAGEL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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 Information

NPI Number:
1386644987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 SUSSEX ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JERVIS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12771-2421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-856-8314
Provider Business Mailing Address Fax Number:
845-856-8315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 SUSSEX ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT JERVIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12771-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-856-8314
Provider Business Practice Location Address Fax Number:
845-856-3875
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRAUNAGEL
Authorized Official First Name:
CARL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-856-8314

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 021257 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01286268 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3322043 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0014316110004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6464211 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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