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NPI Code Detail

MEDICARE: DR. DASEN M BRAJKOVIC MD

MEDICARE: DR. DASEN M BRAJKOVIC MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician273835NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699751974
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DASEN M BRAJKOVIC MD
Provider Business Mailing Address
First Line : 24 LAUREL AVE
Second Line :
City : TENAFLY
State : NJ
Zip : 07670-2118
Country : US
Telephone Number : 201-568-5385
Fax Number : 201-568-0695
Provider Business Practice Location Address
First Line : 5901 PALISADE AVE
Second Line :
City : BRONX
State : NY
Zip : 10471-1205
Country : US
Telephone Number : 917-488-5435
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 04/24/2020

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