MEDICARE: EDGAR G BRAUNSTEIN, MD PA

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	207W00000X	Ophthalmology Physician	MA014103	NJ

General Provider Information

NPI Number	:	1780867184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGAR G BRAUNSTEIN, MD PA

Provider Business Mailing Address
First Line	:	7316 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4035
Country	:	US
Telephone Number	:	201-869-3253
Fax Number	:	201-869-8934

Provider Business Practice Location Address
First Line	:	7316 KENNEDY BLVD
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4035
Country	:	US
Telephone Number	:	201-869-3253
Fax Number	:	201-869-8934

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDGAR G BRAUNSTEIN
Credential	:	M.D.
Telephone Number	:	201-869-3453

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	12/10/2007

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