Dr. Elisa E Bromberg, O.D.
Optometrist in Jackson Heights, NY. Individual provider (NPI-1).
NPI number1710259296
StatusActive
Last updated in NPPESApr 5, 2012
Details
- NPI
- 1710259296
- Entity type
- Individual (NPI-1)
- Name
- Dr. Elisa E Bromberg
- Credential
- O.D.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 31, 2012
- Last updated
- Apr 5, 2012
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 006998 | NY | Yes |
Practice location
8028 37th AveJackson Heights, NY 11372-6720
Phone 718-639-2020 · Fax 718-672-2218
Mailing address
8028 37th AveJackson Heights, NY 11372-6720
Phone 718-639-2020 · Fax 718-672-2218
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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