Provider Demographics
NPI:1275637530
Name:BROTMAN, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BROTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SECOND STREET
Mailing Address - Street 2:SUITE 803
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07311
Mailing Address - Country:US
Mailing Address - Phone:201-416-3702
Mailing Address - Fax:
Practice Address - Street 1:3 SECOND STREET
Practice Address - Street 2:SUITE 803
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07311
Practice Address - Country:US
Practice Address - Phone:201-416-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158789207R00000X
NJ25MA06172600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
16E061Medicare ID - Type Unspecified
A60853Medicare UPIN