Provider Demographics
NPI:1316001977
Name:MASEM, BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:MASEM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2904
Mailing Address - Country:US
Mailing Address - Phone:631-427-6920
Mailing Address - Fax:631-425-0653
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3159
Practice Address - Country:US
Practice Address - Phone:631-207-0083
Practice Address - Fax:631-207-1275
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor