Provider Demographics
NPI:1316095615
Name:JOHN A. BRACH, MD, PC
Entity type:Organization
Organization Name:JOHN A. BRACH, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-383-5450
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-0436
Mailing Address - Country:US
Mailing Address - Phone:518-383-5450
Mailing Address - Fax:518-383-4223
Practice Address - Street 1:2605 HARLEM RD
Practice Address - Street 2:ST. JOSEPHS
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4018
Practice Address - Country:US
Practice Address - Phone:518-383-5450
Practice Address - Fax:518-383-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1391Medicare UPIN