Healthcare Provider Details

I. General information

NPI: 1013832898
Provider Name (Legal Business Name): BRIDGEWAY TRADING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 RALPH AVE
BROOKLYN NY
11221-4109
US

IV. Provider business mailing address

73 RALPH AVE
BROOKLYN NY
11221-4109
US

V. Phone/Fax

Practice location:
  • Phone: 479-265-1075
  • Fax:
Mailing address:
  • Phone: 479-265-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SHAHNAZ MANZOOR
Title or Position: MANAGER
Credential:
Phone: 479-265-1075