Healthcare Provider Details

I. General information

NPI: 1114042462
Provider Name (Legal Business Name): DAVID BYRON BROZYNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 ORIENT WAY 3RD FLOOR
RUTHERFORD NJ
07070-2070
US

IV. Provider business mailing address

PO BOX 1705
RUTHERFORD NJ
07070-0705
US

V. Phone/Fax

Practice location:
  • Phone: 201-939-5500
  • Fax: 201-939-1599
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA05783200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: