Provider Demographics
NPI:1598763625
Name:BRODKIN, JOSHUA S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:S
Last Name:BRODKIN
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 1710
Mailing Address - Street 2:SOUTH JERSEY RADIOLOGY ASSOCIATES, PA
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-7710
Mailing Address - Country:US
Mailing Address - Phone:856-770-0504
Mailing Address - Fax:856-770-0395
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-0535
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA053349002085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7146507Medicaid
A3738029OtherOXFORD HEALTH
BR425676OtherPREMIER BLUE
2232914OtherAETNA
300102339OtherRAILROAD MEDICARE
0258683000OtherAMERIHEALTH HMO
1096595OtherHORIZON NJ HEALTH
425676OtherAMERIHEALTH PPO
10652449OtherCAQH
1940040OtherUNITED HEALTHCARE
BR425676OtherHIGHMARK PA BLUE SHIELD
0258683000OtherAMERIHEALTH HMO
1940040OtherUNITED HEALTHCARE