Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 125-056457 | IL |
Y | 207VX0201X | Gynecologic Oncologist | 269005 | NY |
NPI | 1063649085 |
---|---|
Provider Name | Dr. Vance Andrew Broach |
First Address | New York, NY 10065-6007 |
Second Address | New York, NY 10065-6007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 01/08/2017 |