Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 043007 | NY |
NPI | 1154586733 |
---|---|
Provider Name | Dr. Edward C Brant |
First Address | St James, NY 11780 |
Second Address | St James, NY 11780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2008 |
Last Update Date | 23/07/2008 |