Elizabeth Brondolo, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

010163 Issued in NY

Practice address

274 Madison Ave
Suite 1500
New York, NY 10016-0701

Phone

(212) 942-8532

Fax

(646) 349-4126

NPI assigned

Nov 18, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 15, 2015 through Dec 15, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Manhattan Psychological Services

  • Psychologist
  • New York, NY
  • NPI 1659580785
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447804800000",
    "number": "1649644337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 MADISON AVE",
            "address_2": "SUITE 1500",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100160701",
            "telephone_number": "212-942-8532",
            "fax_number": "646-349-4126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "274 MADISON AVE",
            "address_2": "SUITE 1500",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100160701",
            "telephone_number": "212-942-8532",
            "fax_number": "646-349-4126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONDOLO",
        "first_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-18",
        "last_updated": "2015-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "010163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betsy Bromberg, MS/CCC-A
• Jacqueline F Bromberg, MD
• Gary S Bromley, M.D.
• Julia Bromley, FNP
• Tori Bronaugh, PHD
• Nahama Broner, PHD
• Susan W. Broner, M.D.
• Ludmilla Bronfin, MD
• Kyra Yael Bronfman
• David Bronheim, M.D.

• Clinical Psychologist in New York, NY
• Providers in New York, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.