Provider Demographics
NPI:1902437825
Name:BRODER, MICHELE E WOLFSON (MS, CNS NUTRITION)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:E WOLFSON
Last Name:BRODER
Suffix:
Gender:F
Credentials:MS, CNS NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1612
Mailing Address - Country:US
Mailing Address - Phone:914-424-2912
Mailing Address - Fax:
Practice Address - Street 1:427 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1612
Practice Address - Country:US
Practice Address - Phone:914-424-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist