Provider Demographics
NPI:1093995003
Name:BRUCE K BROWNSTEIN, MD
Entity Type:Organization
Organization Name:BRUCE K BROWNSTEIN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BROWNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-438-2020
Mailing Address - Street 1:1 PENN BLVD
Mailing Address - Street 2:SUITE102
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1476
Mailing Address - Country:US
Mailing Address - Phone:215-438-3030
Mailing Address - Fax:215-951-8985
Practice Address - Street 1:1 PENN BLVD
Practice Address - Street 2:SUITE102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1476
Practice Address - Country:US
Practice Address - Phone:215-438-3030
Practice Address - Fax:215-951-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020980E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA188469Medicare PIN