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General NPI Number Information
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NPI Number | 1700681806
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Entity Type | Individual
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Provider Name | HENRY JRADEH PA
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Gender | Male
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 3319 KINGS HWY APT 1J
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City | BROOKLYN
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State | NY
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Zip | 11234-2622
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Country | US
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Telephone | 718-676-4067
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Fax |
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Provider Business Mailing Address
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Address Line | 3319 KINGS HWY APT 1J
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City | BROOKLYN
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State | NY
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Zip | 11234-2622
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Country | US
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Telephone | 718-676-4067
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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 | 033237
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License Number State | NY
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