Healthcare Provider Details

I. General information

NPI: 1568535342
Provider Name (Legal Business Name): NACHMY BRONSTEIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112-17 68TH ROAD
FOREST HILLS NY
11375-2939
US

IV. Provider business mailing address

112-17 68TH ROAD
FOREST HILLS NY
11375-2939
US

V. Phone/Fax

Practice location:
  • Phone: 917-292-9222
  • Fax:
Mailing address:
  • Phone: 718-268-6929
  • Fax: 201-797-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX004904-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: