Basic Information
| Provider Information | |||||||||
| NPI: | 1841220647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRODY | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11995 SINGLETREE LN STE 500 | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553445349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525951301 | ||||||||
| FaxNumber: | 6122944903 | ||||||||
| Practice Location | |||||||||
| Address1: | 11995 SINGLETREE LN STE 500 | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553445349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525951301 | ||||||||
| FaxNumber: | 6122944903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 07/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 25MB05093300 | NJ | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | OS008113L | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2116731 | 01 | NJ | UNITED HEALTHCARE | OTHER | 010005629 00 | 01 | NJ | AMERICHOICE | OTHER | 1410606 | 01 | NJ | AMERIHEALTH PPO/PA BS | OTHER | P3737597 | 01 | NJ | OXFORD | OTHER | 60003014 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 2098187000 | 01 | NJ | AMERIHEALTH/KEYSTONE/IBC | OTHER | 3342242 | 01 | NJ | AETNA | OTHER | 5469503 | 05 | NJ | MEDICAID | 1410606 | 01 | NJ | PA BS HIGHMARK | OTHER | 2853235 | 01 | NJ | CIGNA | OTHER | 30520 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER |