Healthcare Provider Details

I. General information

NPI: 1952365645
Provider Name (Legal Business Name): DAVID T BROIZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 KINGS HWY N
CHERRY HILL NJ
08034-1502
US

IV. Provider business mailing address

500 KINGS HWY N SUITE 300
CHERRY HILL NJ
08034-1502
US

V. Phone/Fax

Practice location:
  • Phone: 856-667-5910
  • Fax: 856-414-1660
Mailing address:
  • Phone: 856-414-1120
  • Fax: 856-414-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA06172500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: