Healthcare Provider Details

I. General information

NPI: 1700923562
Provider Name (Legal Business Name): ROBERT BROLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 US HIGHWAY 1 SUITE 1
MONMOUTH JUNCTION NJ
08852-1966
US

IV. Provider business mailing address

4250 US HIGHWAY 1 SUITE 1
MONMOUTH JUNCTION NJ
08852-1966
US

V. Phone/Fax

Practice location:
  • Phone: 732-274-3434
  • Fax: 732-274-3435
Mailing address:
  • Phone: 732-274-3434
  • Fax: 732-274-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA03740600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: