Provider Demographics
NPI:1457108532
Name:BRONSTEIN, FAYE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:
Last Name:BRONSTEIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 PROSPECT AVE APT 1I
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1139
Mailing Address - Country:US
Mailing Address - Phone:617-429-4772
Mailing Address - Fax:
Practice Address - Street 1:1139 PROSPECT AVE APT 1I
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1139
Practice Address - Country:US
Practice Address - Phone:617-429-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0295612251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty