1790768224 NPI number — DR. NEIL IRWIN BRODY MD, PHD

Table of content: DR. NEIL IRWIN BRODY MD, PHD (NPI 1790768224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790768224 NPI number — DR. NEIL IRWIN BRODY MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRODY
Provider First Name:
NEIL
Provider Middle Name:
IRWIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1790768224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1578 LAUREL HOLLOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL HOLLOW
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11791-9636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-692-6766
Provider Business Mailing Address Fax Number:
516-692-8666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHASSET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11030-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-365-5652
Provider Business Practice Location Address Fax Number:
516-365-4550
Provider Enumeration Date:
11/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65697 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8027 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1125177310NY . This is a "HORIZON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0037372 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NB03K08920 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C6491 . This is a "GUARDIAN / HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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