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NPI Code Detail

MEDICARE: KONSTANTIN BRODETSKIY

MEDICARE: KONSTANTIN BRODETSKIY
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
1207R00000XInternal Medicine Physician299780NY

General Provider Information

NPI Number : 1720472673
Entity Type Code : Individual
Provider Name (Legal Business Name) : KONSTANTIN BRODETSKIY
Provider Business Mailing Address
First Line : 760 BROADWAY
Second Line :
City : BROOKLYN
State : NY
Zip : 11206-5317
Country : US
Telephone Number : 718-963-8954
Fax Number : 424-310-0327
Provider Business Practice Location Address
First Line : 760 BROADWAY
Second Line :
City : BROOKLYN
State : NY
Zip : 11206-5383
Country : US
Telephone Number : 212-263-5506
Fax Number : 424-310-0327
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2015
Last Update Date : 08/03/2020

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Directions to “ KONSTANTIN BRODETSKIY ” Practice Location

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