Alan Broderson, REG PHARMACIST

Primary specialty

PharmacistTaxonomy code 183500000X

License

025168 Issued in NY

Practice address

136 Summit St
Englewood, NJ 07631-4728

Phone

(201) 921-4276

Fax

(201) 568-2469

NPI assigned

Feb 9, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 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": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992846182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 SUMMIT ST",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314728",
            "telephone_number": "201-921-4276",
            "fax_number": "201-568-2469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 SUMMIT ST",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314728",
            "telephone_number": "201-921-4276",
            "fax_number": "201-568-2469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERSON",
        "first_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "REG PHARMACIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "025168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCE",
            "identifier": "025168",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacist in Englewood, NJ
• Providers in Englewood, NJ by specialty
• Pharmacist in New Jersey

• 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.

Verify at the official NPI Registry.