Healthcare Provider Details

I. General information

NPI: 1346222031
Provider Name (Legal Business Name): BRIAN M DEBROFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MAIN ST
STRATFORD CT
06614-4945
US

IV. Provider business mailing address

3060 MAIN STREET
STRATFORD CT
06614
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-5819
  • Fax: 203-377-4337
Mailing address:
  • Phone: 203-375-5819
  • Fax: 203-377-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number033564
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: