Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X004873 | NY |
NPI | 1003145137 |
---|---|
Provider Name | Dr. Bruce Carl Bromberg |
First Address | Plainview, NY 11803-3953 |
Second Address | Plainview, NY 11803-3953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2009 |
Last Update Date | 21/12/2009 |