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General NPI Number Information
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NPI Number | 1689810335
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Entity Type | Organization
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Legal Business Name | JAMES A BRADY MD PC
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Dates
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Enumeration Date | 12/31/2008
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 686 COUNTY ROAD 39A BUILDING 2
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5703
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Country | US
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Telephone | 631-287-0711
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Fax | 631-287-1080
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Provider Business Mailing Address
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Address Line | PO BOX 6070
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City | SOUTHAMPTON
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State | NY
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Zip | 11969-6070
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Country | US
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Telephone | 631-287-0711
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Fax | 631-287-1080
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES A BRADY
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Credential | MD
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Telephone | 631-287-0711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 201779
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License Number State | NY
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