Provider Demographics
NPI:1750305298
Name:BRODY, GERALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:M
Last Name:BRODY
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 1:43 READ AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-3213
Mailing Address - Country:US
Mailing Address - Phone:914-961-0482
Mailing Address - Fax:
Practice Address - Street 1:43 READ AVE
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3213
Practice Address - Country:US
Practice Address - Phone:914-961-0482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142154-1207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2131753Medicaid
NYF53150Medicare UPIN
NY042H57Medicare ID - Type Unspecified