Provider Demographics
NPI:1225002751
Name:BRADNOCK, HOWARD W (MD)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:W
Last Name:BRADNOCK
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 1:19616 HILLSIDE AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2125
Mailing Address - Country:US
Mailing Address - Phone:718-217-6806
Mailing Address - Fax:718-217-0339
Practice Address - Street 1:196-16 HILLSIDE AVE
Practice Address - Street 2:1ST FL
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2125
Practice Address - Country:US
Practice Address - Phone:718-217-6806
Practice Address - Fax:718-217-0339
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181072207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01547OtherMEDICARE GHI
NY01521879Medicaid
NY01547OtherMEDICARE GHI
NY01521879Medicaid