Provider Demographics
NPI:1679616247
Name:BROZOWSKI, MICHELLE ANN (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ANN
Last Name:BROZOWSKI
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VIVIAN LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1119
Mailing Address - Country:US
Mailing Address - Phone:845-610-3131
Mailing Address - Fax:
Practice Address - Street 1:104 E 40TH ST # 110
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1801
Practice Address - Country:US
Practice Address - Phone:212-584-2610
Practice Address - Fax:212-584-5612
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2011-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000824-12255A2300X
NJ25MT001086002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer