Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 32161 | NJ |
NPI | 1376586412 |
---|---|
Provider Name | Dr. David Bromberg |
First Address | Sewell, NJ 08080-2656 |
Second Address | Sewell, NJ 08080-2656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 26/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C53339 | (02) | NJ |