Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 995 | MA |
NPI | 1063555787 |
---|---|
Provider Name | Dr. Steven J Bromberg |
First Address | Cambridge, MA 02139-1955 |
Second Address | Cambridge, MA 02139-1955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
352352 | HARVARD PILGRIM HEALTH CA (01) | MA |