MEDICARE: DR. MARVIN BRODY DDS

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	122300000X	Dentist	038184	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	:	1659433704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN BRODY DDS

Provider Business Mailing Address
First Line	:	1560 BROADWAY
Second Line	:	SUITE 601
City	:	NEW YORK
State	:	NY
Zip	:	10036-1537
Country	:	US
Telephone Number	:	212-278-8105
Fax Number	:	212-278-8297

Provider Business Practice Location Address
First Line	:	1560 BROADWAY
Second Line	:	SUITE 601
City	:	NEW YORK
State	:	NY
Zip	:	10036-1537
Country	:	US
Telephone Number	:	212-278-8105
Fax Number	:	212-278-8297

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	11/25/2014

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