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General NPI Number Information
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NPI Number | 1013918416
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Entity Type | Individual
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Provider Name | BROOK A DEJENE MD
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 1944 ROUTE 33 MID-ATLANTIC SURGICAL ASSOCIATES - SUITE 201
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City | NEPTUNE
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State | NJ
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Zip | 07753-4862
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Country | US
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Telephone | 732-776-4622
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Fax | 732-776-3765
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Provider Business Mailing Address
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Address Line | 100 MADISON AVE MID-ATLANTIC SURGICAL ASSOCIATES
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6136
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Country | US
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Telephone | 973-971-7300
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Fax | 973-984-7019
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 57722
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License Number State | NJ
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