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General NPI Number Information
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NPI Number | 1972712578
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Entity Type | Individual
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Provider Name | BRADLEY THOMAS HORAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 321 E 34TH ST
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City | NEW YORK
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State | NY
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Zip | 10016-4942
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Country | US
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Telephone | 212-340-0035
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95000-5245
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City | PHILADELPHIA
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State | PA
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Zip | 19195-5245
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Country | US
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Telephone | 212-340-0035
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301082314
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License Number State | MI
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