Individual
JAMES EDWARD BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
470 S PEARL ST, CANANDAIGUA, NY 14424
(585) 394-4070
(585) 394-8563
Mailing address
470 S PEARL ST, CANANDAIGUA, NY 14424
(585) 394-4070
(585) 394-8563
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
N004540
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01158323
—
NY
01
—
480007845
RR MEDICARE
NY
01
—
8110
ROCHESTER BL SHIELD
NY
Enumeration date
08/10/2006
Last updated
11/22/2016
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