Individual
DR. NINA BROGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
622 WEST 168TH STREET, NEW YORK, NY 10032
(212) 305-9335
(212) 305-8636
Mailing address
630 W 168TH ST, NEW YORK, NY 10032-3702
(212) 305-1948
(212) 305-5777
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
221064
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02186203
MEDICAID GROUP#
NY
05
—
02572489
—
NY
01
—
W35021
MEDICARE GROUP#
NY
Enumeration date
05/27/2006
Last updated
11/27/2007
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