Provider Demographics
NPI:1649465642
Name:OBROTKA, THOMAS M (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:OBROTKA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:516 HAMBERG TNPK
Mailing Address - Street 2:STE 10 N JERSEY MED VLG
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-904-0271
Mailing Address - Fax:970-904-1330
Practice Address - Street 1:516 HAMBERG TNPK
Practice Address - Street 2:STE 10 N JERSEY MED VLG
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-904-0271
Practice Address - Fax:970-904-1330
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA029742207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ452039Medicare PIN
NJB25229Medicare UPIN