Provider Demographics
NPI:1740276302
Name:BROSGOL, YURI (MD)
Entity type:Individual
Prefix:
First Name:YURI
Middle Name:
Last Name:BROSGOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2003
Mailing Address - Country:US
Mailing Address - Phone:917-204-0554
Mailing Address - Fax:718-648-0407
Practice Address - Street 1:2459 E 27TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2003
Practice Address - Country:US
Practice Address - Phone:469-763-0549
Practice Address - Fax:718-648-0407
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1972302080P0008X, 2084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01659329Medicaid
NY180984801OtherUNITED HEALTHCARE
NY100180984501OtherAMERICHOICE BY UNITED HEA
NY291720102OtherHEALTH PLUS
NY96X701OtherEMPIRE BC/BS
NY1C4456OtherHEALTHNET
NY3444448OtherAETNA USHC HMO
NYBY7230OtherATLANTIS HEALTH
NY5375627OtherAETNA PPO
NY32255POtherHIP
NYP867555OtherOXFORD
NY197230-C15OtherHEALTHFIRST
NY100180984501OtherAMERICHOICE BY UNITED HEA