Healthcare Provider Details

I. General information

NPI: 1093726473
Provider Name (Legal Business Name): JAMES EDWARD BRODERICK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 S PEARL ST
CANANDAIGUA NY
14424
US

IV. Provider business mailing address

470 S PEARL ST
CANANDAIGUA NY
14424
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-4070
  • Fax: 585-394-8563
Mailing address:
  • Phone: 585-394-4070
  • Fax: 585-394-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004540
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: