Provider Demographics
NPI:1255533659
Name:BROFSKY, JOSEPH (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BROFSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11414
Mailing Address - Country:US
Mailing Address - Phone:516-295-3733
Mailing Address - Fax:516-295-3178
Practice Address - Street 1:932 BROADWAY
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11414
Practice Address - Country:US
Practice Address - Phone:516-295-3733
Practice Address - Fax:516-295-3733
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039092122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00896800Medicaid