Organization Name: | RICHARD C BRADLEY, DPM, PC |
NPI Number: | 1275702284 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD C BRADLETY (PRESIDENT) |
Mailing Address: | 188 Fries Mill Rd Suite D-2 Turnersville |
State: | NJ US |
Postal Code: | 080122015 |
Phone Number: | 8566297300 |
Fax Number: | 8566298729 |
NPI Enumeration Date: | 02/23/2008 |
NPI Last Update Date: | 05/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 25MD00213000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |