Healthcare Provider Details

I. General information

NPI: 1063408995
Provider Name (Legal Business Name): REGINA BRONSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 SPARTA AVE SUITE 100
SPARTA NJ
07871-1777
US

IV. Provider business mailing address

532 LAFAYETTE RD SUITE 300
SPARTA NJ
07871-4411
US

V. Phone/Fax

Practice location:
  • Phone: 973-729-2121
  • Fax: 973-729-3454
Mailing address:
  • Phone: 973-940-0423
  • Fax: 973-940-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07042400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: