Healthcare Provider Details

I. General information

NPI: 1366494973
Provider Name (Legal Business Name): GREGG BROFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 GARDENVILLE PKWY
WEST SENECA NY
14224
US

IV. Provider business mailing address

800 CARTER ST ATTN KELLY STEELE
ROCHESTER NY
14621
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-3600
  • Fax: 716-565-4223
Mailing address:
  • Phone: 585-339-4793
  • Fax: 585-336-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number131752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: