Healthcare Provider Details

I. General information

NPI: 1720292014
Provider Name (Legal Business Name): JASON S. BRATTNER, DC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 RICHMOND RD
STATEN ISLAND NY
10304-2304
US

IV. Provider business mailing address

1272 RICHMOND RD
STATEN ISLAND NY
10304-2304
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-2190
  • Fax: 718-667-7279
Mailing address:
  • Phone: 718-667-2190
  • Fax: 718-667-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008612
License Number StateNY

VIII. Authorized Official

Name: DR. JASON S BRATTNER
Title or Position: PRESIDENT
Credential: DC
Phone: 718-541-9296