Healthcare Provider Details

I. General information

NPI: 1831260702
Provider Name (Legal Business Name): RICHARD RORY BRODMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SOMERSET ST
NORTH PLAINFIELD NJ
07060-4774
US

IV. Provider business mailing address

345 SOMERSET ST
NORTH PLAINFIELD NJ
07060-4774
US

V. Phone/Fax

Practice location:
  • Phone: 908-561-7440
  • Fax: 908-753-9166
Mailing address:
  • Phone: 908-561-7440
  • Fax: 908-753-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA03463600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: