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Organization

BRAVERMAN REPORDUCTIVE IMMUNOLOGY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANDREA VIDALI MD (MEDICAL DIRECTOR)
(516) 584-8710
Entity
Organization

Contact information

Practice address
155 E 76TH ST STE 1H, NEW YORK, NY 10021-2810
(516) 584-8710
(516) 584-8711
Mailing address
135 PINELAWN RD STE 115, MELVILLE, NY 11747-3198
(516) 584-8710
(516) 584-8711

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
195356
NY MEDICAL LICENSE
NY
01
25MA06152700
NJ STATE LICENSE
NJ
Enumeration date
11/04/2011
Last updated
05/31/2022
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