Healthcare Provider Details

I. General information

NPI: 1205909165
Provider Name (Legal Business Name): NANCY DITCH BRONSTEIN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E GENESEE ST SUITE 205
SYRACUSE NY
13210-1968
US

IV. Provider business mailing address

1200 E GENESEE ST SUITE 205
SYRACUSE NY
13210-1968
US

V. Phone/Fax

Practice location:
  • Phone: 315-423-4222
  • Fax: 315-423-0305
Mailing address:
  • Phone: 315-423-4222
  • Fax: 315-423-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300041-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: