Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | G85144 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 206876-1 | NY |
N | 2086S0122X | Plastic and Reconstructive Surgery | G85144 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD050602L | PA |
NPI | 1144257825 |
---|---|
Provider Name | James Paul Bradley |
First Address | New Hyde Park, NY 11042-2062 |
Second Address | New Hyde Park, NY 11042-2062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 02/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G851440 | (05) | CA |
H14458 | (02) | CA |