Provider Demographics
NPI:1154375525
Name:BRODSKY, ADAM (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:BRODSKY
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 1:166 CHERRY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-4828
Mailing Address - Country:US
Mailing Address - Phone:203-323-7331
Mailing Address - Fax:
Practice Address - Street 1:166 CHERRY ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4828
Practice Address - Country:US
Practice Address - Phone:203-323-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044501207XX0004X
NY224652207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I37206Medicare UPIN
007057770Medicare ID - Type Unspecified