Active NPI
Amelia Broda
- Specialist
- Fresh Meadows, NY
National Provider Identifier
1649600537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 716462
- Practice address
- 15813 72ND Ave
Fresh Meadows, NY 11365-1140 - Phone
- (718) 380-7600
- NPI assigned
- Nov 14, 2013
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 716462 | NY | Primary |
Addresses
Primary practice location
15813 72ND Ave
Fresh Meadows, NY 11365-1140
Mailing address
2520 30TH Rd
Astoria, NY 11102-2606
Phone (917) 930-8792
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 |
|---|---|---|---|
| 716462 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384387200000",
"number": "1649600537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2520 30TH RD",
"city": "ASTORIA",
"state": "NY",
"postal_code": "111022606",
"telephone_number": "917-930-8792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15813 72ND AVE",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113651140",
"telephone_number": "718-380-7600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODA",
"first_name": "AMELIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-14",
"last_updated": "2013-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "716462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresh Meadows, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.