MEDICARE: BRA SMYTH

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	332B00000X	Durable Medical Equipment & Medical Supplies		NY

General Provider Information

NPI Number	:	1306020680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRA SMYTH

Provider Business Mailing Address
First Line	:	2177 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6603
Country	:	US
Telephone Number	:	212-721-5111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2177 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6603
Country	:	US
Telephone Number	:	212-721-5111
Fax Number	:

Authorized Official
Title or Position	:	PART OWNER
Name	:	MS. SANDRA A SIMON
Credential	:
Telephone Number	:	212-721-5111

Provider Enumeration Date	:	12/23/2007
Last Update Date	:	07/21/2022

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Directions to “BRA SMYTH ” Practice Location

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