Healthcare Provider Details

I. General information

NPI: 1194263657
Provider Name (Legal Business Name): KAREN F. BRODMAN, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2017
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 COLUMBUS AVE STE 2
NEW YORK NY
10024-1459
US

IV. Provider business mailing address

620 COLUMBUS AVE STE 2
NEW YORK NY
10024-1459
US

V. Phone/Fax

Practice location:
  • Phone: 212-580-3866
  • Fax: 212-580-3867
Mailing address:
  • Phone: 212-580-3866
  • Fax: 212-580-3867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number154126
License Number StateNY

VIII. Authorized Official

Name: KAREN F. BRODMAN
Title or Position: OWNER
Credential: M.D.
Phone: 212-580-3866