Provider Demographics
NPI:1720204019
Name:BROSTOWIN, ROBERT L (DC PC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:BROSTOWIN
Suffix:
Gender:M
Credentials:DC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3487 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2000
Mailing Address - Country:US
Mailing Address - Phone:718-261-6705
Mailing Address - Fax:718-261-6707
Practice Address - Street 1:3487 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2000
Practice Address - Country:US
Practice Address - Phone:516-221-0900
Practice Address - Fax:516-221-0567
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006335-1111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020614752OtherGHI
NY3031202OtherAETNA
NY5G21OtherEMPIRE BC BS
NYC006335-6OtherWORKER COMP.
NYP2679219OtherOXFORD
NY4165432OtherCIGNA
NY4165432OtherCIGNA