Provider Demographics
NPI:1205909165
Name:BRONSTEIN, NANCY DITCH (NP)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:DITCH
Last Name:BRONSTEIN
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 1:1200 E GENESEE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1968
Mailing Address - Country:US
Mailing Address - Phone:315-423-4222
Mailing Address - Fax:315-423-0305
Practice Address - Street 1:1200 E GENESEE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1968
Practice Address - Country:US
Practice Address - Phone:315-423-4222
Practice Address - Fax:315-423-0305
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300041-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS63598Medicare UPIN
DD0668Medicare ID - Type Unspecified