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NPI Code Detail

MEDICARE: DR. JOHN DENNIS BRODERICK M.D.

MEDICARE: DR. JOHN DENNIS BRODERICK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician210877-2NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588666424
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN DENNIS BRODERICK M.D.
Provider Business Mailing Address
First Line : 15 FENIMORE PL
Second Line :
City : GANSEVOORT
State : NY
Zip : 12831-1476
Country : US
Telephone Number : 518-306-5908
Fax Number :
Provider Business Practice Location Address
First Line : 7755 CENTER AVE STE 630
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92647-9152
Country : US
Telephone Number : 657-400-5180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 07/31/2025

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