Provider Demographics
NPI:1417152711
Name:BRUSCHI-BROOK, ANTONELLA (DDS)
Entity Type:Individual
Prefix:
First Name:ANTONELLA
Middle Name:
Last Name:BRUSCHI-BROOK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WRIGHTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-1137
Mailing Address - Country:US
Mailing Address - Phone:914-772-1614
Mailing Address - Fax:914-235-5102
Practice Address - Street 1:175 MEMORIAL HWY STE 3-5
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5641
Practice Address - Country:US
Practice Address - Phone:914-235-2550
Practice Address - Fax:914-235-5102
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043919-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice