Provider Demographics
NPI:1578619573
Name:BRODSKY, DANA EVE (MPH, MSN, CNM)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:EVE
Last Name:BRODSKY
Suffix:
Gender:F
Credentials:MPH, MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MONFORT RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3318
Mailing Address - Country:US
Mailing Address - Phone:516-767-0779
Mailing Address - Fax:
Practice Address - Street 1:3611 21ST ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4705
Practice Address - Country:US
Practice Address - Phone:718-482-7772
Practice Address - Fax:718-482-7658
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000424176B00000X
NY428777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331945Medicare Oscar/Certification
NY00695941Medicaid
NYG140000410Medicare Oscar/Certification
NY331009Medicare Oscar/Certification