Nicole Irene Broderick, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

016018-1 Issued in NY

Practice address

99 E Main St Ste 1
East Islip, NY 11730-2538

Phone

(631) 647-8324

Fax

(631) 352-0051

NPI assigned

Jan 23, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1396375747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 E MAIN ST STE 1",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117302538",
            "telephone_number": "631-647-8324",
            "fax_number": "631-352-0051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 E MAIN ST STE 1",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117302538",
            "telephone_number": "631-647-8324",
            "fax_number": "631-352-0051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "NICOLE",
        "middle_name": "IRENE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-23",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "016018-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "reception@islipchiropractic.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "99 E Main St Ste 1",
            "city": "East Islip",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117302538",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Laura Kristine Bowen, D.C.
• Edana Brady, LPN
• Catherine Brennan, CCC-SLP
• Jonneigh Briody
• Jessica Beth Brock, MS
• Matthew Mi Bullis, LMSW
• Sharon Anne Burke, RD,CDN,RN
• Kimberly Burnor
• Gina M. Candiano, M.S., CCC-SLP
• Shannon A Canfora, MA, CCC SLP

• Massage Therapist in East Islip, NY
• Providers in East Islip, NY by specialty
• Massage Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.