Provider Demographics
NPI:1841220647
Name:BRODY, JOSHUA DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DAVID
Last Name:BRODY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11995 SINGLETREE LN STE 500
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:11995 SINGLETREE LN STE 500
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5349
Practice Address - Country:US
Practice Address - Phone:952-595-1301
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB050933002085R0202X
PAOS008113L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2116731OtherUNITED HEALTHCARE
NJ010005629 00OtherAMERICHOICE
NJ1410606OtherAMERIHEALTH PPO/PA BS
NJP3737597OtherOXFORD
NJ60003014OtherHORIZON NJ HEALTH
NJ2098187000OtherAMERIHEALTH/KEYSTONE/IBC
NJ3342242OtherAETNA
NJ5469503Medicaid
NJ1410606OtherPA BS HIGHMARK
NJ2853235OtherCIGNA
NJ30520OtherUNIVERSITY HEALTH PLAN
NJ010005629 00OtherAMERICHOICE
NJ1410606OtherAMERIHEALTH PPO/PA BS