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Individual

JONATHAN D BRODER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-3220
(585) 922-3518
Mailing address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-3220
(585) 922-3518

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
216942
NY
2085R0204X
Vascular & Interventional Radiology Physician
216942
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02057129
NY
Enumeration date
03/14/2006
Last updated
04/30/2014
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