Healthcare Provider Details

I. General information

NPI: 1619292513
Provider Name (Legal Business Name): BRITTANY BRANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

3839 DANBURY RD
BREWSTER NY
10509-5412
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-7377
  • Fax:
Mailing address:
  • Phone: 845-287-6200
  • Fax: 845-278-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number54109
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: