Provider Demographics
NPI:1912253683
Name:BRACCONERI, EVAN (DPT)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:BRACCONERI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 7TH AVE
Mailing Address - Street 2:STE 905
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5230
Mailing Address - Country:US
Mailing Address - Phone:212-757-7110
Mailing Address - Fax:212-757-7333
Practice Address - Street 1:850 7TH AVE
Practice Address - Street 2:#905
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5230
Practice Address - Country:US
Practice Address - Phone:212-757-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035156-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist