Provider Demographics
NPI:1417393000
Name:BRANNING PODIATRY, PC
Entity type:Organization
Organization Name:BRANNING PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-352-3668
Mailing Address - Street 1:310 SUNRISE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-0509
Mailing Address - Country:US
Mailing Address - Phone:570-352-3668
Mailing Address - Fax:570-352-3669
Practice Address - Street 1:310 SUNRISE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1032
Practice Address - Country:US
Practice Address - Phone:570-352-3668
Practice Address - Fax:570-352-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005984213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA181959Medicare UPIN