IndividualActive
Andre Broussard, M.D.
NPI 1710069695 · Pediatric Sports Medicine Physician · New York, NY
Provider details
- NPI number
- 1710069695
- Entity type
- Individual
- Primary specialty
- Pediatric Sports Medicine PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- License
- MD126425 (NY)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1901 First Ave
523
New York, NY 10029
Phone: (212) 423-6228
Fax: (212) 534-7831
Approximate (ZIP-level) locationGet directions
Mailing address
1901 1st Ave
New York, NY 10029-7404
Registry dates
- Enumerated
- 2006-10-19
- Last updated
- 2007-11-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.