Provider Demographics
NPI:1497794598
Name:BROMBERG, ALICE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:
Last Name:BROMBERG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1702
Mailing Address - Country:US
Mailing Address - Phone:201-664-7444
Mailing Address - Fax:201-664-8610
Practice Address - Street 1:336 CENTER AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1702
Practice Address - Country:US
Practice Address - Phone:201-664-7444
Practice Address - Fax:201-664-8610
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN50117363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics