Healthcare Provider Details

I. General information

NPI: 1295706711
Provider Name (Legal Business Name): MICHAEL L. BRODMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST 2ND FLOOR BOX 1174
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

5 E 98TH ST 2ND FLOOR
NEW YORK NY
10029-6501
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-9393
  • Fax: 212-241-3833
Mailing address:
  • Phone: 212-241-9393
  • Fax: 212-241-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number160731-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: