Provider Demographics
NPI:1366859951
Name:BROMBERG, TEREZA
Entity Type:Individual
Prefix:MRS
First Name:TEREZA
Middle Name:
Last Name:BROMBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 SHORE PKWY
Mailing Address - Street 2:APT 15J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6817
Mailing Address - Country:US
Mailing Address - Phone:718-757-8005
Mailing Address - Fax:
Practice Address - Street 1:2015 SHORE PKWY
Practice Address - Street 2:APT 15J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6817
Practice Address - Country:US
Practice Address - Phone:718-757-8005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY594411121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist