Provider Demographics
NPI:1518940402
Name:BRODSKY, JEFFREY T (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1240 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6369
Practice Address - Country:US
Practice Address - Phone:610-402-7884
Practice Address - Fax:610-402-8876
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043314L208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012441810012Medicaid
PA0012441810013Medicaid
PA0012441810014Medicaid
PA673140OtherHIGHMARK BLUE SHIELD
PA0506425000OtherKEYSTONE IBC
PAP00251847OtherRAILROAD MEDICARE
PA001244181Medicaid
PA4208659OtherAETNA
PA673140OtherPERSONAL CHOICE
PA0012441810014Medicaid
PA673140Medicare ID - Type Unspecified
PA4208659OtherAETNA