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General NPI Number Information
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NPI Number | 1609154806
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Entity Type | Organization
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Legal Business Name | STEWART BRODY DDS
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 17 MAPLE DR
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City | GREAT NECK
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State | NY
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Zip | 11021-2000
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Country | US
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Telephone | 516-482-2215
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Fax | 516-482-5410
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Provider Business Mailing Address
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Address Line | 17 MAPLE DR
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City | GREAT NECK
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State | NY
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Zip | 11021-2000
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Country | US
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Telephone | 516-482-2215
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Fax | 516-482-5410
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Authorized Official
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Title or Position | DENTIST
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Name | STEWART BRODY
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Credential | DDS
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Telephone | 516-482-2215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 040136
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License Number State | NY
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