Healthcare Provider Details

I. General information

NPI: 1740161082
Provider Name (Legal Business Name): ANDREW ERIC BROESLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DREW BROESLER PA-C

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD FL 3
NEWARK DE
19718-2200
US

IV. Provider business mailing address

554 FLORENCE AVE
PITMAN NJ
08071-1831
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-3475
  • Fax: 302-325-7056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012350
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010180
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: