MEDICARE: MRS. PATRICIA ANN BROGAN ADVANCE PRACTICE NUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SG0600X	Gerontology Clinical Nurse Specialist	26NC09345000	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042631UCE	OTHER	NJ	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912944950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ANN BROGAN ADVANCE PRACTICE NUR

Provider Business Mailing Address
First Line	:	1043 ROUTE 70
Second Line	:	UNIT C3
City	:	MANCHESTER
State	:	NJ
Zip	:	08759-5806
Country	:	US
Telephone Number	:	732-657-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 ROUTE 70
Second Line	:	UNIT C3
City	:	MANCHESTER
State	:	NJ
Zip	:	08759-5806
Country	:	US
Telephone Number	:	732-657-6100
Fax Number	:	732-657-0111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	04/29/2013

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