Provider Demographics
NPI:1649438540
Name:BROTMAN-O'NEILL, ALISSA (DO)
Entity type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:
Last Name:BROTMAN-O'NEILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ALISSA
Other - Middle Name:
Other - Last Name:ONEILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:42 E LAUREL RD STE 1300-A
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-566-2710
Mailing Address - Fax:856-256-5772
Practice Address - Street 1:42 E LAUREL RD STE 1300-A
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-2710
Practice Address - Fax:856-256-5772
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MBO81805002086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery