Individual
PAUL E BRODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
73-05 METROPOLITAN AVE, MIDDLE VILLAGE, NY 11379
(718) 894-5888
Mailing address
144-53 72 RD, FLUSHING, NY 11367-2504
(917) 650-5623
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
143755
NY
207N00000X
Dermatology Physician
Primary
143755
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53578
MEDICARE PTAN
NY
Enumeration date
05/16/2007
Last updated
12/09/2013
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