Bromberg, Jordan M

Bromberg, Jordan M is an individual health care provider with primary practice located at 1095 Nw Saint Lucie West Blvd , Port St Lucie FL 34986-1719. He recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as his primary health care specialty. Bromberg, Jordan M can be contacted via phone (772) 223-5665.

Contact Information

Primary practice address
1095 Nw Saint Lucie West Blvd Port St Lucie FL 34986-1719
Phone: (772) 223-5665
Fax: (772) 223-5646
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X ME0045084 Florida

Profile Details

NPI number 1275518391
LBN Legal business name Bromberg, Jordan M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2005
Last updated Oct 9th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275518391 NPPES
Florida MEDICAID 056427300

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