Provider Demographics
NPI:1730447806
Name:SUSAN W BRONER MD PC
Entity type:Organization
Organization Name:SUSAN W BRONER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:BRONER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-616-4125
Mailing Address - Street 1:66 GREENE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4675
Mailing Address - Country:US
Mailing Address - Phone:212-966-1838
Mailing Address - Fax:
Practice Address - Street 1:800 2ND AVE LBBY 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4709
Practice Address - Country:US
Practice Address - Phone:212-616-4125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2336332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty