Provider Demographics
NPI:1629047261
Name:BROMBERG, ASSIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ASSIA
Middle Name:
Last Name:BROMBERG
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 1:19-20 FAIR LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2341
Mailing Address - Country:US
Mailing Address - Phone:201-794-1963
Mailing Address - Fax:201-794-8086
Practice Address - Street 1:19-20 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2341
Practice Address - Country:US
Practice Address - Phone:201-794-1963
Practice Address - Fax:201-794-8086
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05086600207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5345901Medicaid
NJ5345901Medicaid
NJF16909Medicare UPIN
NJ710553WC0Medicare PIN