Healthcare Provider Details

I. General information

NPI: 1548212251
Provider Name (Legal Business Name): WARREN D BROMBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S BEDFORD RD CARE MOUNT MEDICAL PC
MOUNT KISCO NY
10549-3446
US

IV. Provider business mailing address

110 S BEDFORD RD CARE MOUNT MEDICAL PC
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 914-241-1050
  • Fax: 914-242-1516
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number164086
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number164083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: