Provider Demographics
NPI:1053377440
Name:BRODY, DAVID HAROLD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HAROLD
Last Name:BRODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2017
Mailing Address - Country:US
Mailing Address - Phone:845-856-4346
Mailing Address - Fax:845-856-0587
Practice Address - Street 1:56 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2017
Practice Address - Country:US
Practice Address - Phone:845-856-4346
Practice Address - Fax:845-856-0587
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137214207RG0100X
NJ25MA03033700207RG0100X
PAMD021832E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology