Provider Demographics
NPI:1174590988
Name:BRAZIN, STEWART A (MD)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:A
Last Name:BRAZIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 CENTRAL AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1204
Mailing Address - Country:US
Mailing Address - Phone:516-825-8910
Mailing Address - Fax:516-825-8911
Practice Address - Street 1:949 CENTRAL AVE
Practice Address - Street 2:STE 102
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1204
Practice Address - Country:US
Practice Address - Phone:516-825-8910
Practice Address - Fax:516-825-8911
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120299207N00000X
VA31181207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00668355Medicaid
NY070002629OtherRAILROAD MEDICARE
NY0045165OtherGHI
NY070002629OtherRAILROAD MEDICARE
NY00668355Medicaid