Provider Demographics
NPI:1245559459
Name:AVERY, WILLIAM BRADFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRADFORD
Last Name:AVERY
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 1:270 MARIN BLVD
Mailing Address - Street 2:APT. 5 L
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3653
Mailing Address - Country:US
Mailing Address - Phone:860-922-7723
Mailing Address - Fax:
Practice Address - Street 1:270 MARIN BLVD
Practice Address - Street 2:APT. 5 L
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3653
Practice Address - Country:US
Practice Address - Phone:860-922-7723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08763900207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology