MEDICARE: BROOME NEUROSCIENCES, P C

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	174400000X	Specialist	137010	NY
2	174400000X	Specialist	135864	NY

General Provider Information

NPI Number	:	1184771024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOME NEUROSCIENCES, P C

Provider Business Mailing Address
First Line	:	38 FRONT ST
Second Line	:
City	:	BINGHAMTON
State	:	NY
Zip	:	13905-4712
Country	:	US
Telephone Number	:	607-772-9556
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 FRONT ST
Second Line	:
City	:	BINGHAMTON
State	:	NY
Zip	:	13905-4712
Country	:	US
Telephone Number	:	607-772-9556
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SOWBHAGYA L SONTHINENI
Credential	:	MD
Telephone Number	:	607-772-9556

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	10/04/2010

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