Keith Emanuel Bracy, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

056828 Issued in NY

Practice address

100 W 12TH St Apt 1D
New York, NY 10011

Phone

(212) 390-8399

Fax

(509) 275-3412

NPI assigned

Jun 27, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1174887863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W 12TH ST APT 1D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100118241",
            "telephone_number": "212-390-8399",
            "fax_number": "509-275-3412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W 12TH ST APT 1D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10011",
            "telephone_number": "212-390-8399",
            "fax_number": "509-275-3412"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "261 5th Ave Rm 1401",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100167705",
            "country_code": "US",
            "telephone_number": "212-390-8399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRACY",
        "first_name": "KEITH",
        "middle_name": "EMANUEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-27",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "056828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith Michael Brackett, LCSW
• Emily Hermanson Brackman, PHD
• Jessica Brackman
• Matthew R Brackman, MD
• Conner Bracy, MD
• Niles Bracy, PT, DPT
• Brad J. Jacobs, MD.PC
• Mazdak Moghaddam Bradberry, MD, PHD
• Niyah Alise Bradberry
• Michelle S Bradbury, MD, PHD

• Dentist in New York, NY
• Providers in New York, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; 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.