Provider Demographics
NPI:1104053263
Name:BRIAN G. BRAZZO MD P.C.
Entity type:Organization
Organization Name:BRIAN G. BRAZZO MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-734-7788
Mailing Address - Street 1:201 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0830
Mailing Address - Country:US
Mailing Address - Phone:917-748-4542
Mailing Address - Fax:
Practice Address - Street 1:201 E 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0830
Practice Address - Country:US
Practice Address - Phone:917-748-4542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty