Individual
DALLAS BROADWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032, NEW YORK, NY 10032
(877) 426-5637
Mailing address
1010 NW LOOP 410 STE 100B, SAN ANTONIO, TX 78213-2220
(210) 465-7015
(210) 465-7014
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
P8223
TX
261QA1903X
Ambulatory Surgical Clinic/Center
249640
NY
261QA1903X
Ambulatory Surgical Clinic/Center
25MA09187400
NJ
Other
Enumeration date
06/13/2007
Last updated
05/14/2026
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