Provider Demographics
NPI:1831226190
Name:BROREIN, WILLIAM JACOB JR (MD PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JACOB
Last Name:BROREIN
Suffix:JR
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 CLINTON AVE SO
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2623
Mailing Address - Country:US
Mailing Address - Phone:585-461-9600
Mailing Address - Fax:585-461-9437
Practice Address - Street 1:2237 CLINTON AVE SO
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2623
Practice Address - Country:US
Practice Address - Phone:585-461-9600
Practice Address - Fax:585-461-9437
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B72190Medicare UPIN
34831BMedicare ID - Type Unspecified