Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 193401 | NY |
N | 2080P0207X | Pediatric Hematology-Oncologist | 193401 | NY |
NPI | 1245204072 |
---|---|
Provider Name | Dr. Mary Bradley |
First Address | New York, NY 10069-1001 |
Second Address | New York, NC 10032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01788912 | (05) | NY |
H79695 | (02) | NY |