Provider Demographics
NPI:1285819037
Name:FRANK J. BRADY JR DPM
Entity Type:Organization
Organization Name:FRANK J. BRADY JR DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-669-1119
Mailing Address - Street 1:470 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4153
Mailing Address - Country:US
Mailing Address - Phone:973-669-1119
Mailing Address - Fax:973-669-1031
Practice Address - Street 1:470 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4153
Practice Address - Country:US
Practice Address - Phone:973-669-1119
Practice Address - Fax:973-669-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001218213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3136302Medicaid
NJT44720Medicare UPIN
NJ3136302Medicaid