Healthcare Provider Details

I. General information

NPI: 1174927925
Provider Name (Legal Business Name): BRADLEY SCHLUSSEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 W PARK AVE 2ND FLOOR
LONG BEACH NY
11561-3129
US

IV. Provider business mailing address

424 W PARK AVE 2ND FLOOR
LONG BEACH NY
11561-3129
US

V. Phone/Fax

Practice location:
  • Phone: 516-313-7248
  • Fax:
Mailing address:
  • Phone: 516-313-7248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberLP04128
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: