Healthcare Provider Details

I. General information

NPI: 1447272901
Provider Name (Legal Business Name): JONATHAN BRANDES MD,CAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 05/07/2023
Certification Date: 05/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAIN ST #540
NYACK NY
10960
US

IV. Provider business mailing address

99 MAIN ST #540
NYACK NY
10960
US

V. Phone/Fax

Practice location:
  • Phone: 845-535-5824
  • Fax:
Mailing address:
  • Phone: 845-535-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number187228
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberA187228
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: