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NPI Code Detail

MEDICARE: LISA F BRODKIN M.D.

MEDICARE: LISA F BRODKIN M.D.
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
1207R00000XInternal Medicine Physician25MA08572800NJ

General Provider Information

NPI Number : 1972561926
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA F BRODKIN M.D.
Provider Business Mailing Address
First Line : 1 DIAMOND HILL RD
Second Line :
City : BERKELEY HEIGHTS
State : NJ
Zip : 07922-2104
Country : US
Telephone Number : 908-561-8600
Fax Number : 908-561-7265
Provider Business Practice Location Address
First Line : 34 MOUNTAIN BLVD
Second Line :
City : WARREN
State : NJ
Zip : 07059-2640
Country : US
Telephone Number : 908-769-0100
Fax Number : 908-769-2512
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2006
Last Update Date : 07/09/2019

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Directions to “ LISA F BRODKIN M.D.” Practice Location

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