Healthcare Provider Details

I. General information

NPI: 1619300704
Provider Name (Legal Business Name): JAY H BRACHFELD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20937 LYONS RD
BOCA RATON FL
33428-1423
US

IV. Provider business mailing address

20937 LYONS RD
BOCA RATON FL
33428-1423
US

V. Phone/Fax

Practice location:
  • Phone: 561-483-5666
  • Fax:
Mailing address:
  • Phone: 561-483-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME38562
License Number StateFL

VIII. Authorized Official

Name: DR. JAY HOWARD BRACHFELD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-483-5666