Basic Information
| Provider Information | |||||||||
| NPI: | 1144478496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRODER | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 385 PROSPECT AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076012570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519969140 | ||||||||
| FaxNumber: | 5519969140 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 PROSPECT AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076012570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519969140 | ||||||||
| FaxNumber: | 5519969144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2008 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 242042 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | 25MA11268500 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.