Individual
EDWARD JOHN BROCCOLI
Active
Individual
EDWARD JOHN BROCCOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
1934481
NY
207LP2900X
Pain Medicine (Anesthesiology) Physician
1934481
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004487677
AETNA US HEALTHCARE PPO
NY
01
—
3129240
AETNA US HEALTHCARE HMO
NY
01
—
5398369
HEALTH NET
NY
01
—
5398370
GHI
NY
01
—
8K819
EMPIRE BCBS
NY
01
—
P2823545
OXFORD
NY
Enumeration date
10/26/2005
Last updated
01/11/2024
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