Healthcare Provider Details

I. General information

NPI: 1720301989
Provider Name (Legal Business Name): SOUTH BROOKLYN MEDICAL PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3047 BRIGHTON 6TH ST SUITE 2
BROOKLYN NY
11235-6409
US

IV. Provider business mailing address

3047 BRIGHTON 6TH ST SUITE 2
BROOKLYN NY
11235-6409
US

V. Phone/Fax

Practice location:
  • Phone: 718-743-7877
  • Fax: 718-743-4870
Mailing address:
  • Phone: 718-743-7877
  • Fax: 718-743-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DMITRIY BRONFMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-743-7877