Provider Demographics
NPI:1255464707
Name:BROOKMAN, FREDERICK R (DPM)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:R
Last Name:BROOKMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:25 SUTTON PL S
Mailing Address - Street 2:APT. 3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2441
Mailing Address - Country:US
Mailing Address - Phone:212-980-2787
Mailing Address - Fax:212-675-7253
Practice Address - Street 1:157 E 18TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2409
Practice Address - Country:US
Practice Address - Phone:212-675-7591
Practice Address - Fax:212-675-7591
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN005437213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN005437Medicare UPIN