Provider Demographics
NPI:1043363906
Name:DR BRADLEY A BISK PA
Entity Type:Organization
Organization Name:DR BRADLEY A BISK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BISK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-340-4475
Mailing Address - Street 1:1701 EAST DRIVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08406
Mailing Address - Country:US
Mailing Address - Phone:609-487-0485
Mailing Address - Fax:
Practice Address - Street 1:BRIGHTON AND BOARDWALK
Practice Address - Street 2:TROPICANA MEDICAL UNIT
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:609-340-4475
Practice Address - Fax:609-343-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB53615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ53406179JMedicaid
NJB1572321Medicare ID - Type Unspecified
NJ53406179JMedicaid