Provider Demographics
NPI:1023375987
Name:MEDNIK, BRONISLAV
Entity Type:Individual
Prefix:
First Name:BRONISLAV
Middle Name:
Last Name:MEDNIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3104
Mailing Address - Country:US
Mailing Address - Phone:347-251-6664
Mailing Address - Fax:
Practice Address - Street 1:7516 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3104
Practice Address - Country:US
Practice Address - Phone:347-251-6664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic