Provider Demographics
NPI:1164725610
Name:SMITH, BRADLEY DEAN (CO)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:DEAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:813 CARMAN AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6447
Mailing Address - Country:US
Mailing Address - Phone:516-333-7200
Mailing Address - Fax:516-333-7277
Practice Address - Street 1:813 CARMAN AVE UNIT A
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6447
Practice Address - Country:US
Practice Address - Phone:516-333-7200
Practice Address - Fax:516-333-7277
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist