Provider Demographics
NPI:1134258445
Name:BRODIE, JONATHAN D (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:D
Last Name:BRODIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:155 E 38TH ST
Mailing Address - Street 2:APT. 3L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2660
Mailing Address - Country:US
Mailing Address - Phone:212-986-6693
Mailing Address - Fax:212-202-4305
Practice Address - Street 1:155 E 38TH ST
Practice Address - Street 2:APT. 3L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2660
Practice Address - Country:US
Practice Address - Phone:212-986-6693
Practice Address - Fax:212-202-4305
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1272712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08681Medicare UPIN