MEDICARE: MICHAEL L. BRODMAN M.D.

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	207VG0400X	Gynecology Physician	160731-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295706711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL L. BRODMAN M.D.

Provider Business Mailing Address
First Line	:	5 E 98TH ST
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10029-6501
Country	:	US
Telephone Number	:	212-241-9393
Fax Number	:	212-241-3833

Provider Business Practice Location Address
First Line	:	5 E 98TH ST
Second Line	:	2ND FLOOR BOX 1174
City	:	NEW YORK
State	:	NY
Zip	:	10029-6574
Country	:	US
Telephone Number	:	212-241-9393
Fax Number	:	212-241-3833

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/08/2007

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