Provider Demographics
NPI:1851335319
Name:BRADY, ROBERT DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:BRADY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 ORIENT WAY
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2052
Mailing Address - Country:US
Mailing Address - Phone:201-964-0200
Mailing Address - Fax:201-964-0220
Practice Address - Street 1:84 ORIENT WAY
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2052
Practice Address - Country:US
Practice Address - Phone:201-964-0200
Practice Address - Fax:201-964-0220
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB069496174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ061597941OtherTIN
NJ033917S85Medicare ID - Type Unspecified
NJG73819Medicare UPIN