Provider Demographics
NPI:1700923562
Name:BROLIN, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BROLIN
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 1:4250 US HIGHWAY 1
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-1966
Mailing Address - Country:US
Mailing Address - Phone:732-274-3434
Mailing Address - Fax:732-274-3435
Practice Address - Street 1:4250 US HIGHWAY 1
Practice Address - Street 2:SUITE 1
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-1966
Practice Address - Country:US
Practice Address - Phone:732-274-3434
Practice Address - Fax:732-274-3435
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03740600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58721Medicare UPIN