Healthcare Provider Details

I. General information

NPI: 1629177019
Provider Name (Legal Business Name): JAMES JOHN BROSTOWIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3487 JERUSALEM AVE
WANTAGH NY
11793-2000
US

IV. Provider business mailing address

14 PINE EDGE PL
DIX HILLS NY
11746-8146
US

V. Phone/Fax

Practice location:
  • Phone: 516-221-0900
  • Fax:
Mailing address:
  • Phone: 631-243-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX004582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: