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NPI Code Detail

MEDICARE: MS. ELLA BROYTMAN NP

MEDICARE: MS. ELLA BROYTMAN NP
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
1363LF0000XFamily Nurse Practitioner26NJ00944900NJ

General Provider Information

NPI Number : 1992340111
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELLA BROYTMAN NP
Provider Business Mailing Address
First Line : 26-31 WARREN RD APT D
Second Line :
City : FAIR LAWN
State : NJ
Zip : 07410-3325
Country : US
Telephone Number : 917-421-2863
Fax Number :
Provider Business Practice Location Address
First Line : 24-12 FAIR LAWN AVE
Second Line :
City : FAIR LAWN
State : NJ
Zip : 07410-3401
Country : US
Telephone Number : 201-797-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2019
Last Update Date : 06/10/2021

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