Provider Demographics
NPI:1225178452
Name:MARVINBROMBERGPC
Entity Type:Organization
Organization Name:MARVINBROMBERGPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:MOE
Authorized Official - Middle Name:
Authorized Official - Last Name:VOKSHOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-697-4171
Mailing Address - Street 1:104 EAST 40TH STREET
Mailing Address - Street 2:502
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-697-4171
Mailing Address - Fax:
Practice Address - Street 1:104 EAST 40 STREET
Practice Address - Street 2:SUITE 502
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-697-4171
Practice Address - Fax:212-867-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty