Provider Demographics
NPI:1376586412
Name:BROMBERG, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:BROMBERG
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 1:292 HURFFVILLE GRENLOCH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2656
Mailing Address - Country:US
Mailing Address - Phone:856-589-9200
Mailing Address - Fax:856-589-1437
Practice Address - Street 1:292 HURFFVILLE GRENLOCH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2656
Practice Address - Country:US
Practice Address - Phone:856-589-9200
Practice Address - Fax:856-589-1437
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ32161207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53339Medicare UPIN
NJ113913Medicare PIN