Healthcare Provider Details

I. General information

NPI: 1871595462
Provider Name (Legal Business Name): KEVIN BRAAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 OLD COUNTRY ROAD SUITE 16
RIVERHEAD NY
11901-2145
US

IV. Provider business mailing address

660 WHITE PLAINS RD FL 4
TARRYTOWN NY
10591-5139
US

V. Phone/Fax

Practice location:
  • Phone: 631-574-3419
  • Fax: 631-727-8110
Mailing address:
  • Phone: 914-984-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number216843
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: