Healthcare Provider Details

I. General information

NPI: 1679616247
Provider Name (Legal Business Name): MICHELLE ANN BROZOWSKI MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 01/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E 40TH ST # 110
NEW YORK NY
10016-1801
US

IV. Provider business mailing address

16 VIVIAN LN
CHESTER NY
10918-1119
US

V. Phone/Fax

Practice location:
  • Phone: 212-584-2610
  • Fax: 212-584-5612
Mailing address:
  • Phone: 845-610-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000824-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00108600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: