Provider Demographics
NPI:1164972287
Name:VERNIK, BROCHA B (MS ED)
Entity Type:Individual
Prefix:
First Name:BROCHA
Middle Name:B
Last Name:VERNIK
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:BROCHA
Other - Middle Name:B
Other - Last Name:MENCHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED
Mailing Address - Street 1:32 S PARKER DR
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1603
Mailing Address - Country:US
Mailing Address - Phone:410-960-4427
Mailing Address - Fax:
Practice Address - Street 1:32 S PARKER DR
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1603
Practice Address - Country:US
Practice Address - Phone:410-960-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1050332161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist