Provider Demographics
NPI:1679654289
Name:BRONSON, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BRONSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5 E 98TH ST # 1188
Mailing Address - Street 2:MT SINAI MEDICAL CENTER - DEPT OF ORTHOPEDICS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-1640
Mailing Address - Fax:212-534-6202
Practice Address - Street 1:5 E 98TH ST # 1188
Practice Address - Street 2:MT SINAI MEDICAL CENTER - DEPT OF ORTHOPEDICS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-1640
Practice Address - Fax:212-534-6202
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY131262207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01852735Medicaid
NYB14503Medicare UPIN
NY01852735Medicaid