Basic Information
| Provider Information | |||||||||
| NPI: | 1134507510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROTMAN | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | WITKIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 WALL ST FL 9 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100052178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465013224 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1999 MARCUS AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164665222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2015 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 058635 | NY | Y | Dental Providers | Dentist | General Practice |
No ID Information.