Provider Demographics
NPI:1174740419
Name:BROMBERG, TODD
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:BROMBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 OLD YORK RD
Mailing Address - Street 2:SUITE 707
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3706
Mailing Address - Country:US
Mailing Address - Phone:215-576-1800
Mailing Address - Fax:215-576-1860
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:SUITE 707
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3706
Practice Address - Country:US
Practice Address - Phone:215-576-1800
Practice Address - Fax:215-576-1860
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP009962084N0400X
PAMD439937208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine