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NPI Code Detail

MEDICARE: MARTINA BRAVE PA-C

MEDICARE:   MARTINA  BRAVE  PA-C
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1700553716
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTINA BRAVE PA-C
Provider Business Mailing Address
First Line : 70 W 95TH ST APT 3G
Second Line :
City : NEW YORK
State : NY
Zip : 10025-6745
Country : US
Telephone Number : 201-245-2445
Fax Number :
Provider Business Practice Location Address
First Line : 70 W 95TH ST APT 3G
Second Line :
City : NEW YORK
State : NY
Zip : 10025-6745
Country : US
Telephone Number : 201-245-2445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2021
Last Update Date : 08/26/2021

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Directions to “ MARTINA BRAVE PA-C” Practice Location

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