Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 216843 | NY |
NPI | 1871595462 |
---|---|
Provider Name | Dr. Kevin Braat |
First Address | Tarrytown, NY 10591-5139 |
Second Address | Riverhead, NY 11901-2145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02079505 | (05) | NY |
F79085 | (02) | NY |
P00972085 | RAILROAD MEDICARE PIN (01) | NY |