Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 162517 | NY |
NPI | 1043239387 |
---|---|
Provider Name | Dr. Bradley S Rieders |
First Address | Valley Stream, NY 11581-1329 |
Second Address | Valley Stream, NY 11581-1329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 26/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01019254 | (05) | NY |
A65116 | (02) | NY |