NPIMap

Organization Active NPI

Collin Em Brathwaite MD PLLC

  • Surgery Physician
  • Smithtown, NY
National Provider Identifier
1124234489
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
211561 Issued in NY
Legal business name
COLLIN EM BRATHWAITE MD PLLC
Practice address
48 Route 25a
Suite LL7
Smithtown, NY 11787-1431
Phone
(631) 265-7000
Fax
(631) 784-7410
NPI assigned
May 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Barbara Bruno
Title
Pra Ctice Administrator
Phone
(631) 265-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 211561 NY Primary

Addresses

Primary practice location

48 Route 25a
Suite LL7
Smithtown, NY 11787-1431

Mailing address

48 Route 25a
Suite LL7
Smithtown, NY 11787-1431
Phone (631) 265-7000

National Provider Directory

National Provider Directory

Locations

48 Route 25A
Ste LL7
Smithtown, NY 11787
Phone (631) 784-7400

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124234489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 ROUTE 25A",
            "address_2": "SUITE LL7",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117871431",
            "telephone_number": "631-265-7000",
            "fax_number": "631-784-7410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 ROUTE 25A",
            "address_2": "SUITE LL7",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117871431",
            "telephone_number": "631-265-7000",
            "fax_number": "631-784-7410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIN EM BRATHWAITE MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRUNO",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "PRA CTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "631-265-7000"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "NY",
            "license": "211561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithtown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.