Provider Demographics
NPI:1184847410
Name:PROFESSIONAL GYNECOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:PROFESSIONAL GYNECOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DMIETRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:929-252-9234
Mailing Address - Street 1:14 DEKALB AVE 2ND FL
Mailing Address - Street 2:
Mailing Address - City:BKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-0000
Mailing Address - Country:US
Mailing Address - Phone:929-252-9234
Mailing Address - Fax:929-214-4425
Practice Address - Street 1:14 DEKALB AVE 2ND FL
Practice Address - Street 2:
Practice Address - City:BKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-0000
Practice Address - Country:US
Practice Address - Phone:929-252-9234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty