Healthcare Provider Details

I. General information

NPI: 1649465642
Provider Name (Legal Business Name): THOMAS M OBROTKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 HAMBERG TNPK STE 10 N JERSEY MED VLG
WAYNE NJ
07470
US

IV. Provider business mailing address

516 HAMBERG TNPK STE 10 N JERSEY MED VLG
WAYNE NJ
07470
US

V. Phone/Fax

Practice location:
  • Phone: 973-904-0271
  • Fax: 970-904-1330
Mailing address:
  • Phone: 973-904-0271
  • Fax: 970-904-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMA029742
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: