MEDICARE: DR. JEFFERY LEE BRANDE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	186640	NY

General Provider Information

NPI Number	:	1275683120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY LEE BRANDE M.D.

Provider Business Mailing Address
First Line	:	2 W 67TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-6241
Country	:	US
Telephone Number	:	212-873-7302
Fax Number	:	212-873-0396

Provider Business Practice Location Address
First Line	:	2 W 67TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-6241
Country	:	US
Telephone Number	:	212-873-7302
Fax Number	:	212-873-0396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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