Provider Demographics
NPI:1790768224
Name:BRODY, NEIL IRWIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:IRWIN
Last Name:BRODY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1578 LAUREL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:11791-9636
Mailing Address - Country:US
Mailing Address - Phone:516-692-6766
Mailing Address - Fax:516-692-8666
Practice Address - Street 1:1350 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3004
Practice Address - Country:US
Practice Address - Phone:516-365-5652
Practice Address - Fax:516-365-4550
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65697OtherAETNA HMO
NY8027OtherVYTRA
NY1125177310NYOtherHORIZON
NY0037372OtherGHI
NYNB03K08920OtherEMPIRE BC/BS
NY3C6491OtherGUARDIAN / HEALTHNET
NY0037372OtherGHI
NYNB03K08920OtherEMPIRE BC/BS