Provider Demographics
NPI:1447070131
Name:BRONFMAN, ILANA (OD)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:BRONFMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 E 26TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6047
Mailing Address - Country:US
Mailing Address - Phone:646-667-9333
Mailing Address - Fax:
Practice Address - Street 1:519 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7372
Practice Address - Country:US
Practice Address - Phone:718-768-1020
Practice Address - Fax:718-768-1050
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYORT011030-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist