Provider Demographics
NPI:1508801267
Name:BROGADIR, STUART PAUL (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:PAUL
Last Name:BROGADIR
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 1:30 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-0000
Mailing Address - Country:US
Mailing Address - Phone:606-624-4450
Mailing Address - Fax:603-606-3049
Practice Address - Street 1:277 FOREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:606-624-4450
Practice Address - Fax:603-606-3049
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6689207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80006887Medicaid
NHE36890Medicare UPIN
NH80006887Medicaid