Provider Demographics
NPI:1679535041
Name:BRADFORD ORTHOPAEDIC & SPORTS MEDICINE GROUP, PC
Entity Type:Organization
Organization Name:BRADFORD ORTHOPAEDIC & SPORTS MEDICINE GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHABIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-368-1010
Mailing Address - Street 1:54 BOYLSTON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2007
Mailing Address - Country:US
Mailing Address - Phone:814-368-1020
Mailing Address - Fax:814-368-1024
Practice Address - Street 1:54 BOYLSTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2007
Practice Address - Country:US
Practice Address - Phone:814-368-1020
Practice Address - Fax:814-368-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACN8714OtherRAILROAD MEDICARE
PA0019092890005Medicaid
NYCN8715OtherRAILROAD MEDICARE
PA0019092890005Medicaid
NY52749AMedicare PIN