Provider Demographics
NPI:1285070607
Name:BROODIE-MURRAY, NIKO (MD)
Entity type:Individual
Prefix:
First Name:NIKO
Middle Name:
Last Name:BROODIE-MURRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CONNECTICUT BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7303
Mailing Address - Country:US
Mailing Address - Phone:860-282-3894
Mailing Address - Fax:860-282-8582
Practice Address - Street 1:800 CONNECTICUT BLVD
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-7303
Practice Address - Country:US
Practice Address - Phone:860-282-3894
Practice Address - Fax:860-282-8582
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT055484207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program