Healthcare Provider Details

I. General information

NPI: 1811060643
Provider Name (Legal Business Name): DMITRIY BRONFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W END AVE
BROOKLYN NY
11235-4812
US

IV. Provider business mailing address

17 W END AVE
BROOKLYN NY
11235-4812
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 TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number217823
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number217823
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: