Healthcare Provider Details

I. General information

NPI: 1295893337
Provider Name (Legal Business Name): ROBERT A BRODY DPM & FREDERICK D BUXBAUM DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WEST 6 STREET APT 1A
BROOKLYN NY
11204-4949
US

IV. Provider business mailing address

1501 WEST 6 STREET APT 1A
BROOKLYN NY
11204-4949
US

V. Phone/Fax

Practice location:
  • Phone: 718-331-1100
  • Fax: 718-331-1101
Mailing address:
  • Phone: 718-331-1100
  • Fax: 718-331-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT ALLAN BRODY
Title or Position: PRESIDENT
Credential: DPM
Phone: 718-331-1100