MEDICARE: DR. MORRIS I BRODKEY 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	207R00000X	Internal Medicine Physician	MA026272	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831179167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MORRIS I BRODKEY MD

Provider Business Mailing Address
First Line	:	2446 CHURCH ROAD
Second Line	:	SUITE 1-A
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-8175
Country	:	US
Telephone Number	:	732-255-5915
Fax Number	:	732-255-5618

Provider Business Practice Location Address
First Line	:	2446 CHURCH ROAD
Second Line	:	SUITE 1-A
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-8175
Country	:	US
Telephone Number	:	732-255-5915
Fax Number	:	732-255-5618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	05/19/2011

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