Healthcare Provider Details

I. General information

NPI: 1740280148
Provider Name (Legal Business Name): DOUGLAS DAMIEN BRADLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RAHWAY AVE
UNION NJ
07083-6634
US

IV. Provider business mailing address

700 RAHWAY AVE
UNION NJ
07083-6634
US

V. Phone/Fax

Practice location:
  • Phone: 908-688-1999
  • Fax: 908-688-8180
Mailing address:
  • Phone: 908-688-1999
  • Fax: 908-688-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMANJ049904
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: