Provider Demographics
NPI:1174711097
Name:BRAVERMAN, RYAN DAVID (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAVID
Last Name:BRAVERMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1901
Mailing Address - Country:US
Mailing Address - Phone:516-279-6330
Mailing Address - Fax:516-279-6329
Practice Address - Street 1:500 OLD COUNTRY RD
Practice Address - Street 2:SUITE 314
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1901
Practice Address - Country:US
Practice Address - Phone:516-279-6330
Practice Address - Fax:516-279-6330
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor