Healthcare Provider Details

I. General information

NPI: 1811577182
Provider Name (Legal Business Name): REUBEN BRATHWAITE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 FROM ROAD SUITE 506
PARAMUS NJ
07652
US

IV. Provider business mailing address

6 FOREST AVE STE 150
PARAMUS NJ
07652-5245
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-8100
  • Fax: 551-996-4140
Mailing address:
  • Phone: 201-546-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number25MA12717700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA12717700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: