Healthcare Provider Details

I. General information

NPI: 1437313368
Provider Name (Legal Business Name): BROMLEY NEUROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 S WHITE HORSE PIKE SUITE ONE
AUDUBON NJ
08106-1659
US

IV. Provider business mailing address

739 S WHITE HORSE PIKE SUITE ONE
AUDUBON NJ
08106-1659
US

V. Phone/Fax

Practice location:
  • Phone: 856-546-2300
  • Fax: 856-546-2301
Mailing address:
  • Phone: 856-546-2300
  • Fax: 856-546-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA07564200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00144400
License Number StateNJ

VIII. Authorized Official

Name: DR. STEVEN M BROMLEY
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 856-546-2300