Provider Demographics
NPI:1831179167
Name:BRODKEY, MORRIS I (MD)
Entity type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:I
Last Name:BRODKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 CHURCH ROAD
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8175
Mailing Address - Country:US
Mailing Address - Phone:732-255-5915
Mailing Address - Fax:732-255-5618
Practice Address - Street 1:2446 CHURCH ROAD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8175
Practice Address - Country:US
Practice Address - Phone:732-255-5915
Practice Address - Fax:732-255-5618
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA026272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3873404Medicaid
NJE54335Medicare UPIN
NJ116155CMMMedicare ID - Type Unspecified