Provider Demographics
NPI:1962565416
Name:BRAGANZA, ARMANDO MEDINA (MD)
Entity type:Individual
Prefix:DR
First Name:ARMANDO
Middle Name:MEDINA
Last Name:BRAGANZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ETON CT
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-634-1074
Mailing Address - Fax:973-470-3515
Practice Address - Street 1:530 MAIN AVENUE
Practice Address - Street 2:ST MARYS HOSPITAL SETON CENTER
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055
Practice Address - Country:US
Practice Address - Phone:973-470-3514
Practice Address - Fax:973-470-3515
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0540642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F40288Medicare UPIN
144977Medicare ID - Type Unspecified