Basic Information
| Provider Information | |||||||||
| NPI: | 1760877906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAHMA | ||||||||
| FirstName: | VENKATESH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 PAVONIA AVE STE 6 | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073062932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325892616 | ||||||||
| FaxNumber: | 9088454010 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 PAVONIA AVE STE 6 | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073062932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019633937 | ||||||||
| FaxNumber: | 2019638823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2015 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD467131 | PA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 25MA10896300 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.