Provider Demographics
NPI:1457721862
Name:BRODSKY DENTAL PRACTICE
Entity Type:Organization
Organization Name:BRODSKY DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-721-4111
Mailing Address - Street 1:115 CENTRAL PARK W
Mailing Address - Street 2:STE 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4198
Mailing Address - Country:US
Mailing Address - Phone:212-721-4111
Mailing Address - Fax:
Practice Address - Street 1:115 CENTRAL PARK W
Practice Address - Street 2:STE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4198
Practice Address - Country:US
Practice Address - Phone:212-721-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0568491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty