Healthcare Provider Details

I. General information

NPI: 1801720131
Provider Name (Legal Business Name): BRANDEN BOSTON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 COURT ST
PLATTSBURGH NY
12901-2735
US

IV. Provider business mailing address

4941 S CATHERINE ST APT B
PLATTSBURGH NY
12901-3668
US

V. Phone/Fax

Practice location:
  • Phone: 321-400-7043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number885121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: