Provider Demographics
NPI:1508910209
Name:NEVINS, BROOKE JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:JONATHAN
Last Name:NEVINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:130 PONDFIELD RD
Mailing Address - Street 2:STE 2
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4016
Mailing Address - Country:US
Mailing Address - Phone:914-337-1212
Mailing Address - Fax:914-337-2847
Practice Address - Street 1:130 PONDFIELD RD
Practice Address - Street 2:STE 2
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4016
Practice Address - Country:US
Practice Address - Phone:914-337-1212
Practice Address - Fax:914-337-2847
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2021-07-07
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Provider Licenses
StateLicense IDTaxonomies
NY143067207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B18785Medicare UPIN