Provider Demographics
NPI:1831187574
Name:BROMBERG, MARGARET (NP)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:BROMBERG
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 1:25 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1244
Mailing Address - Country:US
Mailing Address - Phone:716-592-2832
Mailing Address - Fax:716-592-4452
Practice Address - Street 1:25 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1244
Practice Address - Country:US
Practice Address - Phone:716-592-2832
Practice Address - Fax:716-592-4452
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380474363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560135006OtherBC/BS
NY00020023903OtherUNIVERA
NY9512073OtherIHA
NY01963482Medicaid
NY00020023903OtherUNIVERA
S04585Medicare UPIN