Provider Demographics
NPI:1588027056
Name:MICHAEL S. BRODHERSON
Entity Type:Organization
Organization Name:MICHAEL S. BRODHERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL BRODHERSON
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BRODHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-696-5912
Mailing Address - Street 1:4 E 76TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2676
Mailing Address - Country:US
Mailing Address - Phone:212-794-2749
Mailing Address - Fax:212-717-6130
Practice Address - Street 1:4 E 76TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2676
Practice Address - Country:US
Practice Address - Phone:212-794-2749
Practice Address - Fax:212-717-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120531208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty