Individual
JILLENE MYRNELLE BRATHWAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
40 ARCH ST, JOHNSON CITY, NY 13790-2102
(607) 763-6092
(607) 763-6677
Mailing address
346 GRAND AVE, JOHNSON CITY, NY 13790-2580
(607) 729-8156
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
254046
NY
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
254046
NY
208M00000X
Hospitalist Physician
254046
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03128012
—
NY
Enumeration date
07/17/2009
Last updated
07/05/2012
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