Basic Information
| Provider Information | |||||||||
| NPI: | 1639533664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAMER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | JEFFREY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 GRAHAM RD W | ||||||||
| Address2: | |||||||||
| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148501055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072575958 | ||||||||
| FaxNumber: | 6072667341 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 GRAHAM RD W | ||||||||
| Address2: | |||||||||
| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148501055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072575958 | ||||||||
| FaxNumber: | 6072667341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2016 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 300038 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.