Provider Demographics
NPI:1568474542
Name:BRODKOWITZ, MILTON BARNEY (MS-AUDIOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:MILTON
Middle Name:BARNEY
Last Name:BRODKOWITZ
Suffix:
Gender:M
Credentials:MS-AUDIOLOGIST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:561-478-8770
Mailing Address - Fax:561-598-7231
Practice Address - Street 1:3 PENN PLZ E
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2258
Practice Address - Country:US
Practice Address - Phone:973-522-1292
Practice Address - Fax:973-522-1294
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ41YA00020200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2490911000OtherAMERIHEALTH
NJ81994OtherAMERIGROUP
NJ157553Q6XMedicare PIN