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General NPI Number Information
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NPI Number | 1649165945
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Entity Type | Individual
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Provider Name | EMILY BRIENNE BRODER OD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2770 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10025-2811
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Country | US
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Telephone | 121-267-8053
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Fax |
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Provider Business Mailing Address
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Address Line | 66 COMMONWEALTH DR
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City | GLENMONT
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State | NY
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Zip | 12077-3214
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Country | US
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Telephone | 518-506-2157
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0
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License Number State | NY
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