Provider Demographics
NPI:1467491985
Name:HANDLER, BRADLEY JASON
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JASON
Last Name:HANDLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1147
Mailing Address - Country:US
Mailing Address - Phone:212-523-7035
Mailing Address - Fax:212-590-2982
Practice Address - Street 1:1780 BROADWAY
Practice Address - Street 2:SUITE 1100
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1414
Practice Address - Country:US
Practice Address - Phone:212-590-2930
Practice Address - Fax:212-590-2982
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1914832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02433769Medicaid
NYG50854Medicare UPIN
NY02433769Medicaid