Provider Demographics
NPI:1528170362
Name:DWORKIN, BRAD MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:MITCHELL
Last Name:DWORKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:NYMC-MUNGER PAVILION
Mailing Address - Street 2:SUITE 206
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-493-7337
Mailing Address - Fax:914-594-4317
Practice Address - Street 1:NYMC-MUNGER PAVILION
Practice Address - Street 2:SUITE 206
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-7337
Practice Address - Fax:914-594-4317
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131555207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4416441OtherAETNA PPO
NY117417OtherWELLCARE
NY131555OtherHIP
NY131555-A1SOtherHEALTHFIRST
NY0W0194OtherHEALTHNET
NY100013636OtherRAILROAD MEDICARE
NY727144OtherMVP
NY73A161OtherEMPIRE BC/BS
NYWS434OtherOXFORD
NY000000046383OtherGHI HMO
NY0088041OtherGHI PPO
NY003890OtherCONNECTICARE
NY2172814OtherAETNA HMO
NY003890OtherCONNECTICARE
NY4416441OtherAETNA PPO