Provider Demographics
NPI:1477647055
Name:BRONZO, RICHARD LAWRENCE X (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:BRONZO
Suffix:X
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 EAST SHORE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023
Mailing Address - Country:US
Mailing Address - Phone:516-466-5166
Mailing Address - Fax:516-466-7828
Practice Address - Street 1:192 EAST SHORE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023
Practice Address - Country:US
Practice Address - Phone:516-466-5166
Practice Address - Fax:516-466-7828
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131009207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY47A741OtherEMPIRE BCBS
NY4310165OtherAETNA
NYAS1127OtherOXFORD
NY47A741OtherEMPIRE BCBS
NYAS1127OtherOXFORD