Provider Demographics
NPI:1497518468
Name:BRODSKY, MARLY (CHES)
Entity Type:Individual
Prefix:
First Name:MARLY
Middle Name:
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TERRY DR UNIT 190
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-4908
Mailing Address - Country:US
Mailing Address - Phone:760-583-1553
Mailing Address - Fax:
Practice Address - Street 1:355 COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-8025
Practice Address - Country:US
Practice Address - Phone:760-583-1553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
38821251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
38821OtherNATIONAL COMMISSION FOR HEALTH EDUCATION CREDENTIALING