Doctor Name: | STANLEY BROVENDER |
NPI Number: | 1740612829 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 010547 |
Business Practice Address: | 773b Pontiac Lane Stratford, CT - 06614 |
Business Phone Number: | 2033819882 |
Business Fax Number: | |
Mailing Address: | 773b Pontiac Lane, STRATFORD |
State: | CT |
Postal Code: | 06614 |
Phone Number: | 2033819882 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2013 |
NPI Last Update Date: | 07/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 010547 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |