Provider Demographics
NPI:1053462937
Name:BRADY, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:BRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6070
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-6070
Mailing Address - Country:US
Mailing Address - Phone:631-287-0711
Mailing Address - Fax:631-287-1080
Practice Address - Street 1:686 COUNTY ROAD 39A
Practice Address - Street 2:BUILDING 2
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5703
Practice Address - Country:US
Practice Address - Phone:631-287-0711
Practice Address - Fax:631-287-1080
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201779208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5I3501Medicare ID - Type Unspecified
NYH44211Medicare UPIN