Provider Demographics
NPI:1043415128
Name:BROOKMEAD MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BROOKMEAD MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ENGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-427-4001
Mailing Address - Street 1:432 COLUMBIA BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1625
Mailing Address - Country:US
Mailing Address - Phone:856-427-4001
Mailing Address - Fax:856-427-4003
Practice Address - Street 1:432 COLUMBIA BLVD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1625
Practice Address - Country:US
Practice Address - Phone:856-427-4001
Practice Address - Fax:856-427-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06304700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092598Medicare ID - Type Unspecified
NJ093402Medicare ID - Type Unspecified