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General NPI Number Information
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NPI Number | 1598557308
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Entity Type | Individual
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Provider Name | KORY WILLIAM BROUGHTON
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Gender | Male
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10016-5802
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Country | US
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Telephone | 212-254-7722
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Fax | 646-548-8976
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Provider Business Mailing Address
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Address Line | 210 E 181ST ST APT 6M
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City | BRONX
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State | NY
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Zip | 10457-2149
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Country | US
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Telephone | 347-255-9762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 033032
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License Number State | NY
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