Individual
BRYAN BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
125 PATERSON ST, NEW BRUNSWICK, NJ 08901-1962
(732) 235-6874
Mailing address
125 PATERSON ST # 7312, NEW BRUNSWICK, NJ 08901-1962
(732) 235-6874
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA12217600
NJ
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
25MA12217600
NJ
207RP1001X
Pulmonary Disease Physician
Primary
25MA12217600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA12217600
LICENSE
NJ
01
—
D89495
LICENSE
MD
Enumeration date
03/23/2017
Last updated
01/02/2025
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