Healthcare Provider Details

I. General information

NPI: 1518182039
Provider Name (Legal Business Name): ROBERT MICHAEL BRODSKY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 EMMONS AVE SUITE 415
BROOKLYN NY
11235-1148
US

IV. Provider business mailing address

3235 EMMONS AVE SUITE 415
BROOKLYN NY
11235-1148
US

V. Phone/Fax

Practice location:
  • Phone: 718-646-7000
  • Fax:
Mailing address:
  • Phone: 718-646-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX-2709
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: