Provider Demographics
NPI:1144257825
Name:BRADLEY, JAMES PAUL (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:PAUL
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1991 MARCUS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2062
Mailing Address - Country:US
Mailing Address - Phone:516-497-7912
Mailing Address - Fax:516-497-7928
Practice Address - Street 1:1991 MARCUS AVE STE 102
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2062
Practice Address - Country:US
Practice Address - Phone:516-497-7912
Practice Address - Fax:516-497-7928
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85144204E00000X, 2082S0099X, 2086S0122X
PAMD050602L2086S0122X
NY206876-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G851440Medicaid
CA00G851440Medicaid
CACK390ZMedicare PIN
CAH14458Medicare UPIN