Active NPI
Keely A Broderick
- Speech-Language Pathologist
- Brooklyn, NY
National Provider Identifier
1104388016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 024376
- Practice address
- 201 Conselyea St
Brooklyn, NY 11211-2516 - Phone
- (516) 458-3311
- NPI assigned
- Apr 1, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 024376 | NY | Primary |
Addresses
Primary practice location
201 Conselyea St
Brooklyn, NY 11211-2516
Mailing address
10 Franklin Ave
Sea Cliff, NY 11579-1858
Phone (516) 458-3311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024376 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665705600000",
"number": "1104388016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 FRANKLIN AVE",
"city": "SEA CLIFF",
"state": "NY",
"postal_code": "115791858",
"telephone_number": "516-458-3311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 CONSELYEA ST",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112112516",
"telephone_number": "516-458-3311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERICK",
"first_name": "KEELY",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-01",
"last_updated": "2022-10-14",
"certification_date": "2022-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "024376",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.