Individual
PHYLLIS BROEGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
013412
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02070735
—
NY
01
—
680014530
RR MEDICARE
NY
Enumeration date
10/12/2005
Last updated
11/13/2019
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