Healthcare Provider Details

I. General information

NPI: 1417905415
Provider Name (Legal Business Name): DAVID BRODY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 WYNCREST RD
MARLBORO NJ
07746-2248
US

IV. Provider business mailing address

81 WYNCREST RD
MARLBORO NJ
07746-2248
US

V. Phone/Fax

Practice location:
  • Phone: 732-536-6666
  • Fax: 732-536-1229
Mailing address:
  • Phone: 732-536-6666
  • Fax: 732-536-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI00984100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: