Provider Demographics
NPI:1588730667
Name:BRAHMS, DANA LYN S (MD)
Entity type:Individual
Prefix:
First Name:DANA LYN
Middle Name:S
Last Name:BRAHMS
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 1:28 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1479
Mailing Address - Country:US
Mailing Address - Phone:973-835-2575
Mailing Address - Fax:973-835-0531
Practice Address - Street 1:28 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1479
Practice Address - Country:US
Practice Address - Phone:973-835-2575
Practice Address - Fax:973-835-0531
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07786300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0245283Medicaid
NJ141195MDJMedicare PIN