Provider Demographics
NPI:1356432769
Name:BRONSKY, MARK J (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:BRONSKY
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:530 PARK AVE STE 1G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8015
Mailing Address - Country:US
Mailing Address - Phone:212-758-0040
Mailing Address - Fax:212-758-7771
Practice Address - Street 1:530 PARK AVE STE 1G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8015
Practice Address - Country:US
Practice Address - Phone:212-758-0040
Practice Address - Fax:212-758-7771
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU29261Medicare UPIN