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General NPI Number Information
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NPI Number | 1053457556
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Entity Type | Individual
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Provider Name | KATHLEEN M BRADBURY PA
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 BROOKDALE PLZ
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City | BROOKLYN
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State | NY
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Zip | 11212-3139
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Country | US
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Telephone | 718-240-5982
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 MARINE PKWY
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City | BROOKLYN
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State | NY
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Zip | 11234-4454
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Country | US
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Telephone | 718-376-3555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002352-1
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License Number State | NY
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