Healthcare Provider Details

I. General information

NPI: 1285631267
Provider Name (Legal Business Name): HERBERT A BRONSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5877 CLEVELAND AVENUE
COLUMBUS OH
43231-2859
US

IV. Provider business mailing address

PO BOX 183027 DEPT LB-05
COLUMBUS OH
43218-3027
US

V. Phone/Fax

Practice location:
  • Phone: 614-891-0550
  • Fax: 614-891-0429
Mailing address:
  • Phone: 614-891-0550
  • Fax: 614-891-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number35-02-4253
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: