MEDICARE: DR. MARK J BRONSKY D.M.D., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	043039	NY

General Provider Information

NPI Number	:	1356432769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J BRONSKY D.M.D., M.S.

Provider Business Mailing Address
First Line	:	530 PARK AVE STE 1G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-8015
Country	:	US
Telephone Number	:	212-758-0040
Fax Number	:	212-758-7771

Provider Business Practice Location Address
First Line	:	530 PARK AVE STE 1G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-8015
Country	:	US
Telephone Number	:	212-758-0040
Fax Number	:	212-758-7771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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