Provider Demographics
NPI:1366494973
Name:BROFFMAN, GREGG (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:BROFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CARTER ST
Mailing Address - Street 2:ATTN KELLY STEELE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-339-4793
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:120 GARDENVILLE PKWY
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-668-3600
Practice Address - Fax:716-565-4223
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY131752208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050216000044OtherFIDELIS
NYP00201738OtherMEDICARE RAILROAD
NY10520422OtherCAQH
NY159628DLOtherPREFERRED CARE
NY000000089397OtherGHI
NY000500324010OtherBCBS
NY050216000049OtherFIDELIS
NY00010021101OtherUNIVERA
NY10495518OtherCAQH
NY050216000049OtherFIDELIS
NY050216000044OtherFIDELIS