Healthcare Provider Details

I. General information

NPI: 1992777494
Provider Name (Legal Business Name): ABBY SUE BRODKIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 DEKALB PIKE SUITE 202A
NORRISTOWN PA
19401-1852
US

IV. Provider business mailing address

2705 DEKALB PIKE SUITE 202A
NORRISTOWN PA
19401-1852
US

V. Phone/Fax

Practice location:
  • Phone: 610-277-2025
  • Fax: 610-277-1273
Mailing address:
  • Phone: 610-277-2025
  • Fax: 610-277-1273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberOS005102L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: