Individual
THEODOR BROCKWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
550 1ST AVE, NEW YORK, NY 10016
(212) 263-7300
Mailing address
358 LEWIS AVE APT 2, BROOKLYN, NY 11233-1118
(415) 630-0346
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
702059
NY
Other
Enumeration date
06/18/2018
Last updated
08/09/2022
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