Christina Rose Broderick, MSED
Individual provider Active NPI Specialist · Bethpage, NY
NPI 1619215423 · NPPES record last updated Jan 29, 2013
Key facts
- NPI
- 1619215423
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 162 Broadway
Bethpage, NY 11714-4417 - Phone
- (516) 547-3658
- NPI assigned
- Jan 29, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | NY | Yes |
Addresses
Primary practice location
162 Broadway
Bethpage, NY 11714-4417
Mailing address
162 Broadway
Bethpage, NY 11714-4417
Phone (516) 547-3658
Other providers in Bethpage, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.