Organization Active NPI

Michael C Braunstein MD PLLC

  • Specialist
  • Farmingdale, NY
National Provider Identifier
1356734131
Registry record updated Mar 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
148696 Issued in NY
Legal business name
MICHAEL C BRAUNSTEIN MD PLLC
Practice address
1111 Broadhollow Rd
Suite 205
Farmingdale, NY 11735-4820
Phone
(631) 226-6717
Fax
(631) 226-6793
NPI assigned
Mar 18, 2015
Last updated
Mar 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2015

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

Authorized official

Name
Dr. Michael Braunstein, MDNPI 1770657595
Title
Sole Proprietor
Phone
(516) 301-7740

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 148696 NY Primary

Addresses

Primary practice location

1111 Broadhollow Rd
Suite 205
Farmingdale, NY 11735-4820

Mailing address

1111 Broadhollow Rd
Suite 205
Farmingdale, NY 11735-4820
Phone (631) 226-6717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150326001663 NY Part B Supplier - Clinic/Group Practice 2466779608 Receives reassigned benefits from 1 practitioner
Practice locations: Farmingdale, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0886080Michael C Braunstein MD PLLC1111 Broadhollow Road, Suite 205, Farmingdale, NY 11735Certificate of waiverMar 5, 2027

National Provider Directory

National Provider Directory

Locations

1111 Route 110
Ste 205
Farmingdale, NY 11735
Phone (631) 226-6717

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1426636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426636800000",
    "number": "1356734131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 BROADHOLLOW RD",
            "address_2": "SUITE 205",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117354820",
            "telephone_number": "631-226-6717",
            "fax_number": "631-226-6793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 BROADHOLLOW RD",
            "address_2": "SUITE 205",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117354820",
            "telephone_number": "631-226-6717",
            "fax_number": "631-226-6793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL C BRAUNSTEIN MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-18",
        "last_updated": "2015-03-18",
        "status": "A",
        "authorized_official_last_name": "BRAUNSTEIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "SOLE PROPRIETOR",
        "authorized_official_telephone_number": "516-301-7740",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "148696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmingdale, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.