Provider Demographics
NPI:1861816654
Name:HRADECKY, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:HRADECKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 ELM ST # 248
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2105
Mailing Address - Country:US
Mailing Address - Phone:603-540-6564
Mailing Address - Fax:
Practice Address - Street 1:816 ELM ST # 248
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2105
Practice Address - Country:US
Practice Address - Phone:603-540-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies