Healthcare Provider Details

I. General information

NPI: 1487667713
Provider Name (Legal Business Name): NEIL M. BRODSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241-01 NORTHERN BOULEVARD FIRST FLOOR
DOUGLASTON NY
11362-1061
US

IV. Provider business mailing address

241-01 NORTHERN BOULEVARD FIRST FLOOR
DOUGLASTON NY
11362-1061
US

V. Phone/Fax

Practice location:
  • Phone: 718-461-0163
  • Fax:
Mailing address:
  • Phone: 718-461-0163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number180013
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: