Healthcare Provider Details

I. General information

NPI: 1255327821
Provider Name (Legal Business Name): BETSY BROMBERG MS/CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E 41ST ST FL 8
NEW YORK NY
10017-6739
US

IV. Provider business mailing address

222 E 41ST ST FL 8
NEW YORK NY
10017-6739
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-7567
  • Fax:
Mailing address:
  • Phone: 212-263-7567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number001059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: