Provider Demographics
NPI:1568046589
Name:BRONSTEIN, MADISON ANNE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ANNE
Last Name:BRONSTEIN
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 1:11 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-9631
Mailing Address - Country:US
Mailing Address - Phone:908-797-4357
Mailing Address - Fax:
Practice Address - Street 1:80 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6301
Practice Address - Country:US
Practice Address - Phone:646-740-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist