Provider Demographics
NPI:1316381619
Name:SAMIT, BRADLEY NOEL (RN)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:NOEL
Last Name:SAMIT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11388 HOLLAND GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14080-9664
Mailing Address - Country:US
Mailing Address - Phone:716-432-2899
Mailing Address - Fax:
Practice Address - Street 1:11388 HOLLAND GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:NY
Practice Address - Zip Code:14080-9664
Practice Address - Country:US
Practice Address - Phone:716-432-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY479758163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse