Provider Demographics
NPI:1710926340
Name:BROMLEY, CHRISTOPHER KENT (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KENT
Last Name:BROMLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:243 NORTH RD STE 304
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1173
Mailing Address - Country:US
Mailing Address - Phone:845-471-9410
Mailing Address - Fax:845-471-7372
Practice Address - Street 1:22 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2422
Practice Address - Country:US
Practice Address - Phone:845-454-0630
Practice Address - Fax:845-454-0637
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY65 004988213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1793752OtherNYS EMPIRE PLAN UNITED HEALTHCARE LEGACY NUMBER
1C8554OtherPHS LEGACY NUMBER
000405793008OtherBSNENY LEGACY NUMBER
NY01515315Medicaid
10032229OtherCDPHP LEGACY NUMBER
200053170OtherMVP HEALTH PLAN GROUP LEGACY NUMBER
39099OtherGHI HMO SELECT LEGACY NUMBER
953501OtherMVP HEALTH PLAN LEGACY NUMBER
408871001OtherBSNENY GROUP LEGACY NUMBER
505870OtherAETNA US LEGACY NUMBER
6200857OtherGHI LEGACY NUMBER
139099OtherWELLCARE LEGACY NUMBER
30061OtherLAST 5 TIN
P82109OtherSECURE HORIZONS LEGACY NUMBER
P821809BOtherOXFORD HEALTH CARE LEGACY NUMBER
100107789201OtherUNITED HEALTHCARE LEGACY NUMBER
1235164997OtherGROUP PRACTICE NPI
1793752OtherUNITED HEALTHCARE GROUP LEGACY NUMBER
200053170OtherMVP HEALTHCARE GROUP LEGACY NUMBER
33D0164140OtherCLIA IDENTIFIER
CB0P565510OtherBLUE CROSS BLUE SHIELD LEGACY NUMBER
CJ2100OtherRAILROAD MEDICARE GROUP LEGACY NUMBER
109052400OtherGOVERNMENT WORKERS COMP
5934707OtherAETNA LEGACY NUMBER
P821809BOtherOXFORD HEALTHCARE LEGACY NUMBER
CJ2100OtherRAILROAD MEDICARE GROUP LEGACY NUMBER
200053170OtherMVP HEALTHCARE GROUP LEGACY NUMBER
NY01515315Medicaid
109052400OtherGOVERNMENT WORKERS COMP
39099OtherGHI HMO SELECT LEGACY NUMBER
6200857OtherGHI LEGACY NUMBER