Individual
CHRISTINE BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
700C LAKE ST, RAMSEY, NJ 07446-1372
(201) 962-7454
(201) 962-7455
Mailing address
112 CARTER RD, HASKELL, NJ 07420-1060
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QA00928600
LICENSE #
NJ
Enumeration date
08/30/2006
Last updated
01/04/2012
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