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General NPI Number Information
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NPI Number | 1376712356
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Entity Type | Organization
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Legal Business Name | HOWARD BRADNOCK MD PC
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 19616 HILLSIDE AVE
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City | HOLLIS
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State | NY
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Zip | 11423-2125
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Country | US
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Telephone | 718-217-6806
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Fax | 718-217-0339
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Provider Business Mailing Address
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Address Line | 19616 HILLSIDE AVE
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City | HOLLIS
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State | NY
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Zip | 11423-2125
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Country | US
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Telephone | 718-217-6806
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Fax | 718-217-0339
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOWARD W BRADNOCK
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Credential | MD
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Telephone | 718-217-6806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 181072
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License Number State | NY
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