Provider Demographics
NPI:1275845745
Name:BRADBIE, DENISE (MS, LAC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BRADBIE
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 N 7TH ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:169 WYTHE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-3102
Practice Address - Country:US
Practice Address - Phone:646-427-8139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25 004322171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist