Provider Demographics
NPI:1427306141
Name:BROOK, JOEL (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:BROOK
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 1:139 TODDY HILL ROAD
Mailing Address - Street 2:MASONICARE AT NEWTOWN
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470
Mailing Address - Country:US
Mailing Address - Phone:203-364-3258
Mailing Address - Fax:203-364-3223
Practice Address - Street 1:139 TODDY HILL ROAD
Practice Address - Street 2:MASONICARE AT NEWTOWN
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470
Practice Address - Country:US
Practice Address - Phone:203-364-3258
Practice Address - Fax:203-364-3223
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17019207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT17019OtherLICENSE