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General NPI Number Information
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NPI Number | 1497074249
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Entity Type | Organization
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Legal Business Name | JAMES E. BRODERICK
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 470 S PEARL ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1702
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Country | US
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Telephone | 585-394-4070
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Fax | 585-394-8563
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Provider Business Mailing Address
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Address Line | 470 S PEARL ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1702
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Country | US
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Telephone | 585-394-4070
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Fax | 585-394-8563
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Authorized Official
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Title or Position | PODIATRIST
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Name | JAMES E BRODERICKD
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Credential | DPM
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Telephone | 585-394-4070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N004540
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License Number State | NY
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