Provider Demographics
NPI:1578914321
Name:BRADLEY, JULIA C
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:C
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 YOUNG RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:12850-2425
Mailing Address - Country:US
Mailing Address - Phone:518-583-7281
Mailing Address - Fax:
Practice Address - Street 1:50 YOUNG RD
Practice Address - Street 2:
Practice Address - City:MIDDLE GROVE
Practice Address - State:NY
Practice Address - Zip Code:12850-2425
Practice Address - Country:US
Practice Address - Phone:518-583-7281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist