Provider Demographics
NPI:1891954962
Name:BRADLEY ARDEN RADWANER, M.D., P.C.
Entity Type:Organization
Organization Name:BRADLEY ARDEN RADWANER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ARDEN
Authorized Official - Last Name:RADWANER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-717-0666
Mailing Address - Street 1:927 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0250
Mailing Address - Country:US
Mailing Address - Phone:212-717-0666
Mailing Address - Fax:212-717-2399
Practice Address - Street 1:136 E 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2707
Practice Address - Country:US
Practice Address - Phone:212-717-0666
Practice Address - Fax:212-717-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150577261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWYXQY1Medicare PIN