MEDICARE: ROBERT L. BROSTOWIN DC PC

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	111NN0400X	Neurology Chiropractor	X006335-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5G21	OTHER	NY	EMPIRE BC BS
2	C006335-6	OTHER	NY	WORKER COMP.
3	3031202	OTHER	NY	AETNA
4	5898013	OTHER	NY	GHI
5	4165432	OTHER	NY	CIGNA
6	P2679219	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1427264514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT L. BROSTOWIN DC PC

Provider Business Mailing Address
First Line	:	7150 AUSTIN ST STE 102
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4731
Country	:	US
Telephone Number	:	718-261-6705
Fax Number	:	718-261-6707

Provider Business Practice Location Address
First Line	:	7150 AUSTIN ST STE 102
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4731
Country	:	US
Telephone Number	:	718-261-6705
Fax Number	:	718-261-6707

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT L BROSTOWIN
Credential	:	DC PC
Telephone Number	:	718-261-6705

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	04/20/2008

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