Provider Demographics
NPI:1902846090
Name:BRONNER, ELAINE F (NP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:F
Last Name:BRONNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 TONAWANDA RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-2608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LIBERTY HEALTH CENTER
Practice Address - Street 2:106 LIBERTY STREET
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1008
Practice Address - Country:US
Practice Address - Phone:212-227-7227
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300146-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health