Provider Demographics
NPI:1265401566
Name:BRONSTEIN, ERIC H (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:H
Last Name:BRONSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-0417
Mailing Address - Fax:606-408-6069
Practice Address - Street 1:613 23RD ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2878
Practice Address - Country:US
Practice Address - Phone:606-326-9847
Practice Address - Fax:606-326-3418
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66089174400000X
KY44393208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ02557591Medicaid
NJ02557591Medicaid
NJ960074Medicare ID - Type Unspecified