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Larry B. Broisman

Internal Medicine

Allopathic & Osteopathic Physicians

300 Kensington Ave, New Britain, CT 06051-3916

PECOS Enrollment

This provider is enrolled in PECOS as LARRY BROISMAN.

Based on the most recent information from CMS, provider Larry B. Broisman is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 2:56 PM.

Profile Details

Provider ID
1174525497
Provider Type
Individual
Full Name
Broisman, Larry B.
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
6/1/2005
Last Updated
7/10/2007

Contact Information

Practice Location

300 Kensington Ave, New Britain, CT 06051-3916

(860) 832-8150

(860) 224-6298

Mailing Location

300 Kensington Ave, New Britain, CT 06051-3916

(860) 832-8150

(860) 224-6298

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 022071 Connecticut

Provider Identifiers

ID	Description	Issuer
ID 050648	Description Other	Issuer CONNECTICARE Connecticut
ID 135713	Description Other	Issuer WELLCARE MEDICARE Connecticut
ID 511575	Description Other	Issuer AETNA Connecticut
ID 010022071CT02	Description Other	Issuer BCBS & BCFP PROVIDER ID Connecticut
ID P369844	Description Other	Issuer OXFORD PROVIDER ID Connecticut
ID 1255448155	Description Other	Issuer GHMC GROUP NPI PROVIDER I Connecticut
ID C01373	Description Other	Issuer GHMC GROUP MEDICARE ID Connecticut
ID 060103	Description Other	Issuer HEALTH NET PROVIDER ID Connecticut
ID 01322071	Description Other	Issuer CIGNA PROVIDER ID Connecticut

Larry B. Broisman

PECOS Enrollment

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