Provider Demographics
NPI:1912438342
Name:WILLIAM J. BROREIN, JR., M.D., PH.D.
Entity Type:Organization
Organization Name:WILLIAM J. BROREIN, JR., M.D., PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:BROREIN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:585-461-9600
Mailing Address - Street 1:2237 CLINTON AVE S
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 S
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB72190Medicare UPIN