Healthcare Provider Details

I. General information

NPI: 1366292229
Provider Name (Legal Business Name): GREGORY R BROTSKE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5400
US

IV. Provider business mailing address

6 DEER COMMON DR
SCITUATE MA
02066-2154
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-3180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN2331035
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: