Provider Demographics
NPI:1295893337
Name:ROBERT A BRODY DPM & FREDERICK D BUXBAUM DPM PC
Entity type:Organization
Organization Name:ROBERT A BRODY DPM & FREDERICK D BUXBAUM DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-331-1100
Mailing Address - Street 1:1501 WEST 6 STREET
Mailing Address - Street 2:APT 1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4949
Mailing Address - Country:US
Mailing Address - Phone:718-331-1100
Mailing Address - Fax:718-331-1101
Practice Address - Street 1:1501 WEST 6 STREET
Practice Address - Street 2:APT 1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4949
Practice Address - Country:US
Practice Address - Phone:718-331-1100
Practice Address - Fax:718-331-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4709320001Medicare NSC