Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 258796 | NY |
Y | 207Q00000X | Family Doctor | 61935 | CT |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 258796 | NY |
N | 208D00000X | General Practice Physician | 258796 | NY |
NPI | 1093024887 |
---|---|
Provider Name | Amber Michelle Brody |
First Address | Larchmont, NY 10538-3031 |
Second Address | Larchmont, NY 10538-3031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2010 |
Last Update Date | 30/08/2019 |