Provider Demographics
NPI:1467756981
Name:BETH S. BROMBERG, M.D., P.C.
Entity Type:Organization
Organization Name:BETH S. BROMBERG, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-962-5054
Mailing Address - Street 1:334 UNDERHILL AVE
Mailing Address - Street 2:BLDG 4 SUITE B
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-4530
Mailing Address - Country:US
Mailing Address - Phone:914-962-5054
Mailing Address - Fax:914-962-8115
Practice Address - Street 1:334 UNDERHILL AVE
Practice Address - Street 2:BLDG 4 SUITE B
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4530
Practice Address - Country:US
Practice Address - Phone:914-962-5054
Practice Address - Fax:914-962-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164082207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE20964Medicare UPIN