Provider Demographics
NPI:1760406342
Name:THOMAS M. OBROTKA MD
Entity Type:Organization
Organization Name:THOMAS M. OBROTKA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:OBROTKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-904-0271
Mailing Address - Street 1:516 HAMBURG TPKE
Mailing Address - Street 2:N JERSEY MEDICAL VILLAGE STE 10
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2062
Mailing Address - Country:US
Mailing Address - Phone:973-904-0271
Mailing Address - Fax:973-904-1330
Practice Address - Street 1:516 HAMBURG TPKE
Practice Address - Street 2:N JERSEY MEDICAL VILLAGE STE 10
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2062
Practice Address - Country:US
Practice Address - Phone:973-904-0271
Practice Address - Fax:973-904-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ452039Medicare PIN
NJB25229Medicare UPIN