MEDICARE: AMBER MICHELLE BRODY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	258796	NY
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	258796	NY
3	208D00000X	General Practice Physician	258796	NY
4	207Q00000X	Family Medicine Physician	61935	CT

General Provider Information

NPI Number	:	1093024887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MICHELLE BRODY D.O.

Provider Business Mailing Address
First Line	:	1890 PALMER AVENUE
Second Line	:	STE 304
City	:	LARCHMONT
State	:	NY
Zip	:	10538-3031
Country	:	US
Telephone Number	:	914-834-9606
Fax Number	:	914-834-0648

Provider Business Practice Location Address
First Line	:	1890 PALMER AVENUE
Second Line	:	STE 304
City	:	LARCHMONT
State	:	NY
Zip	:	10538-3031
Country	:	US
Telephone Number	:	914-834-9606
Fax Number	:	914-834-0648

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	08/30/2019

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