Healthcare Provider Details

I. General information

NPI: 1124627336
Provider Name (Legal Business Name): BRAVERCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 60TH ST
BROOKLYN NY
11219-5023
US

IV. Provider business mailing address

1527 60TH ST
BROOKLYN NY
11219-5023
US

V. Phone/Fax

Practice location:
  • Phone: 718-336-6073
  • Fax:
Mailing address:
  • Phone: 718-336-6073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL BENEDEK
Title or Position: DIRECTOR
Credential:
Phone: 718-336-6073