Provider Demographics
NPI:1376590513
Name:BROKER, MARTIN H (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:H
Last Name:BROKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EXCHANGE PL
Mailing Address - Street 2:14TH FLOOR WSBS
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3918
Mailing Address - Country:US
Mailing Address - Phone:201-830-3122
Mailing Address - Fax:201-200-0838
Practice Address - Street 1:3131 KINGS HWY
Practice Address - Street 2:SUITE A-4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2644
Practice Address - Country:US
Practice Address - Phone:718-758-1500
Practice Address - Fax:718-758-2400
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1525142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01049793Medicaid
NY01049793Medicaid
NY86D921Medicare PIN