Provider Demographics
NPI:1649361312
Name:BRODY, PAUL DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DOUGLAS
Last Name:BRODY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:45 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7724
Mailing Address - Country:US
Mailing Address - Phone:631-424-8494
Mailing Address - Fax:631-920-8501
Practice Address - Street 1:45 BALSAM DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7724
Practice Address - Country:US
Practice Address - Phone:631-424-8494
Practice Address - Fax:631-920-8501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1697872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03F021Medicare UPIN