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General NPI Number Information
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NPI Number | 1124640305
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Entity Type | Individual
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Provider Name | MACKENZIE ANNE BRADLEY OD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 33 W 42ND ST
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City | NEW YORK
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State | NY
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Zip | 10036-8005
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Country | US
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Telephone | 212-938-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 4 GORDON AVE
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City | BRIARCLIFF MANOR
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State | NY
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Zip | 10510-1509
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Country | US
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Telephone | 973-897-9715
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV009204-01
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License Number State | NY
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