MEDICARE: DR. ABE ISAAC BRONNER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2121079	NJ
2	122300000X	Dentist	042274	NY

General Provider Information

NPI Number	:	1053337972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABE ISAAC BRONNER DDS

Provider Business Mailing Address
First Line	:	622 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4132
Country	:	US
Telephone Number	:	718-382-0707
Fax Number	:	718-375-9899

Provider Business Practice Location Address
First Line	:	622 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4132
Country	:	US
Telephone Number	:	718-382-0707
Fax Number	:	718-375-9899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	12/10/2010

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