Provider Demographics
NPI:1538360466
Name:BROITMAN, ZVI GENADIY (DDS)
Entity type:Individual
Prefix:DR
First Name:ZVI
Middle Name:GENADIY
Last Name:BROITMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 BEAUMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4120
Mailing Address - Country:US
Mailing Address - Phone:718-891-0821
Mailing Address - Fax:
Practice Address - Street 1:623 BRIGHTON BEACH AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6424
Practice Address - Country:US
Practice Address - Phone:718-891-0821
Practice Address - Fax:718-891-0867
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043255-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01230395Medicaid