Healthcare Provider Details

I. General information

NPI: 1366458895
Provider Name (Legal Business Name): JILL BRAVERMAN-PANZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TALLOW WOOD DR
CLIFTON PARK NY
12065-2807
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-451-7530
  • Fax: 518-621-5710
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number163681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: