Healthcare Provider Details

I. General information

NPI: 1114900321
Provider Name (Legal Business Name): ELLEN J BRAND O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 6TH AVE HERALD SQUARE OPTOMETRIC ASSOCIATES (2ND FLOOR)
NEW YORK NY
10001-3505
US

IV. Provider business mailing address

1323 ECHO HILL PATH
YORKTOWN HEIGHTS NY
10598-5703
US

V. Phone/Fax

Practice location:
  • Phone: 212-967-4177
  • Fax: 212-967-2101
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004261-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: