Broder, Jonathan D

Broder, Jonathan D is an individual health care provider with primary practice located at 1425 Portland Ave , Rochester NY 14621-3001. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Broder, Jonathan D can be contacted via phone (585) 922-3220.

Contact Information

Primary practice address
1425 Portland Ave Rochester NY 14621-3001
Phone: (585) 922-3220
Fax: (585) 922-3518
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 216942 New York
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 216942 New York

Profile Details

NPI number 1477522514
LBN Legal business name Broder, Jonathan D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated Apr 30th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477522514 NPPES
New York MEDICAID 02057129

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