Active NPI
Gregg Broffman, MD
- Pediatrics Physician
- West Seneca, NY
National Provider Identifier
1366494973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 131752
- Practice address
- 120 Gardenville Pkwy
West Seneca, NY 14224 - Phone
- (716) 668-3600
- Fax
- (716) 565-4223
- NPI assigned
- May 16, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 131752 | NY | Primary |
Addresses
Primary practice location
120 Gardenville Pkwy
West Seneca, NY 14224
Mailing address
800 Carter St
Attn Kelly Steele
Rochester, NY 14621
Phone (585) 339-4793
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 050216000044 | Other | NY | FIDELIS |
| P00201738 | Other | NY | MEDICARE RAILROAD |
| 10520422 | Other | NY | CAQH |
| 159628DL | Other | NY | PREFERRED CARE |
| 000000089397 | Other | NY | GHI |
| 000500324010 | Other | NY | BCBS |
| 050216000049 | Other | NY | FIDELIS |
| 00010021101 | Other | NY | UNIVERA |
| 10495518 | Other | NY | CAQH |
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 |
|---|---|---|---|
| 131752 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366494973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 CARTER ST",
"address_2": "ATTN KELLY STEELE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "14621",
"telephone_number": "585-339-4793",
"fax_number": "585-336-4845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 GARDENVILLE PKWY",
"city": "WEST SENECA",
"state": "NY",
"postal_code": "14224",
"telephone_number": "716-668-3600",
"fax_number": "716-565-4223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROFFMAN",
"first_name": "GREGG",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "131752",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS",
"identifier": "050216000044",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00201738",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "10520422",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE",
"identifier": "159628DL",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "000000089397",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "000500324010",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIDELIS",
"identifier": "050216000049",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNIVERA",
"identifier": "00010021101",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "10495518",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Seneca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.