Provider Demographics
NPI:1902089394
Name:BRAVERMAN, VICTOR H (RPH)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:H
Last Name:BRAVERMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1820
Mailing Address - Country:US
Mailing Address - Phone:516-239-8389
Mailing Address - Fax:
Practice Address - Street 1:1270 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3211
Practice Address - Country:US
Practice Address - Phone:212-560-9811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-09
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045200-11835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy