Provider Demographics
NPI:1457420267
Name:BRAUNSTEIN, ELLEN JOY (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:JOY
Last Name:BRAUNSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1204
Mailing Address - Country:US
Mailing Address - Phone:516-374-7246
Mailing Address - Fax:516-374-4408
Practice Address - Street 1:949 CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1204
Practice Address - Country:US
Practice Address - Phone:516-374-7246
Practice Address - Fax:516-374-4408
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157489174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0034355OtherGHI
92D821OtherBLUE CROSS BLUE SHIELD
AS1680OtherOXFORD
097523OtherAETNA
AS1680OtherOXFORD
NYB20173Medicare UPIN