Active NPI
Michael Brodin, M.D.
- Dermatology Physician
- Los Gatos, CA
National Provider Identifier
1326046921
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 142123-1
- Practice address
- 16400 Soda Springs Rd
Los Gatos, CA 95033-8621 - Phone
- (914) 625-8600
- Fax
- (888) 254-5368
- NPI assigned
- Jul 8, 2005
- Last updated
- Apr 27, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 142123-1 | NY | Primary |
Addresses
Primary practice location
16400 Soda Springs Rd
Los Gatos, CA 95033-8621
Mailing address
PO Box 745
Chester, NY 10918-0745
Phone (914) 625-8600
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 142123-1 | NY | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461715200000",
"number": "1326046921",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 745",
"city": "CHESTER",
"state": "NY",
"postal_code": "109180745",
"telephone_number": "914-625-8600",
"fax_number": "888-254-5368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16400 SODA SPRINGS RD",
"city": "LOS GATOS",
"state": "CA",
"postal_code": "950338621",
"telephone_number": "914-625-8600",
"fax_number": "888-254-5368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODIN",
"first_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-08",
"last_updated": "2016-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NY",
"license": "142123-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Gatos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.