MEDICARE: THOMAS M. OBROTKA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1760406342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS M. OBROTKA MD

Provider Business Mailing Address
First Line	:	516 HAMBURG TPKE
Second Line	:	N JERSEY MEDICAL VILLAGE STE 10
City	:	WAYNE
State	:	NJ
Zip	:	07470-2062
Country	:	US
Telephone Number	:	973-904-0271
Fax Number	:	973-904-1330

Provider Business Practice Location Address
First Line	:	516 HAMBURG TPKE
Second Line	:	N JERSEY MEDICAL VILLAGE STE 10
City	:	WAYNE
State	:	NJ
Zip	:	07470-2062
Country	:	US
Telephone Number	:	973-904-0271
Fax Number	:	973-904-1330

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. THOMAS MATTHEW OBROTKA
Credential	:	MD
Telephone Number	:	973-904-0271

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	09/12/2007

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