Healthcare Provider Details

I. General information

NPI: 1740276302
Provider Name (Legal Business Name): YURI BROSGOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 E 27TH ST FL 2
BROOKLYN NY
11235-2003
US

IV. Provider business mailing address

2459 E 27TH ST
BROOKLYN NY
11235-2003
US

V. Phone/Fax

Practice location:
  • Phone: 917-204-0554
  • Fax: 316-348-8303
Mailing address:
  • Phone: 917-204-0554
  • Fax: 718-648-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number197230
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number197230
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: