Provider Demographics
NPI:1649378704
Name:BROMBERG, BETH SHAPIRO (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:SHAPIRO
Last Name:BROMBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:334 UNDERHILL AVENUE
Mailing Address - Street 2:BUILDING #4 SUITE B
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598
Mailing Address - Country:US
Mailing Address - Phone:914-962-5054
Mailing Address - Fax:914-962-8115
Practice Address - Street 1:334 UNDERHILL AVENUE
Practice Address - Street 2:BUILDING #4 SUITE B
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598
Practice Address - Country:US
Practice Address - Phone:914-962-5054
Practice Address - Fax:914-962-8115
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY164082207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
55019OtherOXFORD
1C7537OtherHEALTHNET
E20964Medicare UPIN
1C7537OtherHEALTHNET