Nancy Broderick, LMT
Individual provider Active NPI Massage Therapist · Park Ridge, NJ
NPI 1811477995 · NPPES record last updated Aug 17, 2018
Key facts
- NPI
- 1811477995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 18KT01129500 (NJ)
- Practice address
- 74 Pascack Rd Ste 5
Park Ridge, NJ 07656-1941 - Phone
- (201) 323-1218
- NPI assigned
- Aug 17, 2018
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18KT01129500 | NJ | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 18KT01129500 | NJ | Yes |
Addresses
Primary practice location
74 Pascack Rd Ste 5
Park Ridge, NJ 07656-1941
Mailing address
22 Montvale Ave
Montvale, NJ 07645-1425
Phone (201) 323-1218
Other practice location 1
22 Montvale Ave
Montvale, NJ 07645-1425
Phone (201) 323-1218
Other providers in Park Ridge, NJ
- Blooming Health LLC
- Stephanie Blum
- Keri Bratcher
- Evalynne Velez Braun
- Joseph Adams Braun
- Dana Brodhecker
- Deborah Renee Brodt Donnelly
- Brook Medical Care PC
- Christopher Lynn Brundage
- Cali Cares LLC
All providers in Park Ridge, NJ · Massage Therapist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2018. 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.