Provider Demographics
NPI:1629158498
Name:RADLER, BRUCE LOUIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LOUIS
Last Name:RADLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6416 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2739
Mailing Address - Country:US
Mailing Address - Phone:718-236-2821
Mailing Address - Fax:718-236-1167
Practice Address - Street 1:6416 17TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2739
Practice Address - Country:US
Practice Address - Phone:718-236-2821
Practice Address - Fax:718-236-1167
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0023551213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY38810OtherELDERPLAN HMO
NY00413314Medicaid
NYN0023551OtherHIP
NYP26231OtherEMPIRE BC/BS
NY0058524OtherGHI
NYP26231Medicare ID - Type UnspecifiedEMPIRE
NY38810OtherELDERPLAN HMO
NY05741GMedicare ID - Type UnspecifiedGHI