Provider Demographics
NPI:1275788598
Name:BRONSTEIN, STEPHANIE ROBIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROBIN
Last Name:BRONSTEIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 82ND ST
Mailing Address - Street 2:3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2746
Mailing Address - Country:US
Mailing Address - Phone:516-641-6769
Mailing Address - Fax:212-933-4190
Practice Address - Street 1:200 E 82ND STREET
Practice Address - Street 2:3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:516-641-6769
Practice Address - Fax:212-933-4190
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010659252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency