Provider Demographics
NPI:1134507510
Name:BROTMAN, ERIC WITKIE (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WITKIE
Last Name:BROTMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WALL ST FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2178
Mailing Address - Country:US
Mailing Address - Phone:646-501-3224
Mailing Address - Fax:
Practice Address - Street 1:1999 MARCUS AVE STE 110
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1028
Practice Address - Country:US
Practice Address - Phone:516-466-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0586351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice