Provider Demographics
NPI:1376712356
Name:HOWARD BRADNOCK MD PC
Entity Type:Organization
Organization Name:HOWARD BRADNOCK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRADNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-217-6806
Mailing Address - Street 1:19616 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2125
Mailing Address - Country:US
Mailing Address - Phone:718-217-6806
Mailing Address - Fax:718-217-0339
Practice Address - Street 1:19616 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2125
Practice Address - Country:US
Practice Address - Phone:718-217-6806
Practice Address - Fax:718-217-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181072207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01547Medicare PIN
NY60J911Medicare PIN