Provider Demographics
NPI:1104939651
Name:BRAIM, TIMOTHY EDWARD (OD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:BRAIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HIGHVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-3641
Mailing Address - Country:US
Mailing Address - Phone:518-859-3936
Mailing Address - Fax:518-541-3757
Practice Address - Street 1:228 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1244
Practice Address - Country:US
Practice Address - Phone:518-439-7012
Practice Address - Fax:518-541-3757
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004260-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00854348Medicaid
NY38662CMedicare ID - Type Unspecified
NY00854348Medicaid
NYP01320767Medicare PIN
NYJ300088272Medicare PIN