Provider Demographics
NPI:1093024887
Name:BRODY, AMBER MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MICHELLE
Last Name:BRODY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1890 PALMER AVENUE
Mailing Address - Street 2:STE 304
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3031
Mailing Address - Country:US
Mailing Address - Phone:914-834-9606
Mailing Address - Fax:914-834-0648
Practice Address - Street 1:1890 PALMER AVENUE
Practice Address - Street 2:STE 304
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3031
Practice Address - Country:US
Practice Address - Phone:914-834-9606
Practice Address - Fax:914-834-0648
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2019-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY258796207Q00000X, 207QG0300X, 208D00000X, 207QH0002X
CT61935207Q00000X
PAOS015458207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine