Basic Information
| Provider Information | |||||||||
| NPI: | 1174501498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRODEY | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W FAYETTE ST | ||||||||
| Address2: | STE 400 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132042859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154721488 | ||||||||
| FaxNumber: | 3154728060 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 BROAD RD | ||||||||
| Address2: | POB STE 4K | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132152265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154925784 | ||||||||
| FaxNumber: | 3154925183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 141878 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | 141878 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.