Provider Demographics
NPI:1689810335
Name:JAMES A BRADY MD PC
Entity Type:Organization
Organization Name:JAMES A BRADY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-287-0711
Mailing Address - Street 1:PO BOX 6070
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-6070
Mailing Address - Country:US
Mailing Address - Phone:631-287-0711
Mailing Address - Fax:631-287-1080
Practice Address - Street 1:686 COUNTY ROAD 39A
Practice Address - Street 2:BUILDING 2
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5703
Practice Address - Country:US
Practice Address - Phone:631-287-0711
Practice Address - Fax:631-287-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201779208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH44211Medicare UPIN