Healthcare Provider Details

I. General information

NPI: 1285808287
Provider Name (Legal Business Name): JASON BRANT CARMEL MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT WASHINGTON AVE RM 540
NEW YORK NY
10032-3735
US

IV. Provider business mailing address

622 W 168TH ST
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 917-301-1882
  • Fax:
Mailing address:
  • Phone: 917-301-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number235314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: