1457400657 NPI number — NORMAN BROUDY

Table of content: (NPI 1457400657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457400657 NPI number — NORMAN BROUDY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORMAN BROUDY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457400657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 N WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19801-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-655-7110
Provider Business Mailing Address Fax Number:
302-655-6185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19801-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-655-7110
Provider Business Practice Location Address Fax Number:
302-655-6185
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROUDY
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
LEAD DOCTOR
Authorized Official Telephone Number:
302-655-7110

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  0000473 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: B10000333 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: B10000381 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: B10000110 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: B10000234 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: LE0000140 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: C10006767 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: C10007596 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: C10001649 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: Q10000120 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: Q10000260 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: Q10000773 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: Q10000129 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: PC0000237 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PC0000237 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000473 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: B10000234 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: Q10000129 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: Q10000260 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: Q10000120 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: C10007596 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: PC0000003 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: B10000381 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: C10001649 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: LE0000140 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: B10000110 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: B10000333 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: C10006767 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: PC0000224 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: Q10000773 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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