Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X009135-1 | NY |
NPI | 1396843736 |
---|---|
Provider Name | Dr. Lauren E Brady |
First Address | Endwell, NY 13760-5815 |
Second Address | Endwell, NY 13760-5815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 03/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70083 | (02) | NY |