Healthcare Provider Details

I. General information

NPI: 1427264514
Provider Name (Legal Business Name): ROBERT L. BROSTOWIN DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 AUSTIN ST STE 102
FOREST HILLS NY
11375-4731
US

IV. Provider business mailing address

7150 AUSTIN ST STE 102
FOREST HILLS NY
11375-4731
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-6705
  • Fax: 718-261-6707
Mailing address:
  • Phone: 718-261-6705
  • Fax: 718-261-6707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberX006335-1
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT L BROSTOWIN
Title or Position: OWNER
Credential: DC PC
Phone: 718-261-6705