Healthcare Provider Details

I. General information

NPI: 1821017393
Provider Name (Legal Business Name): ANDREW BRONIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 RYE RIDGE PLZ
RYE BROOK NY
10573-2820
US

IV. Provider business mailing address

4 RYE RIDGE PLZ
RYE BROOK NY
10573-2820
US

V. Phone/Fax

Practice location:
  • Phone: 914-253-8080
  • Fax:
Mailing address:
  • Phone: 914-253-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number127272
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number019985
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number127272
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number019985
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number127272
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number019985
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: