Provider Demographics
NPI:1013118132
Name:BRADEN, WILLIAM F JR (DC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:BRADEN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 14TH ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2428
Mailing Address - Country:US
Mailing Address - Phone:732-237-4537
Mailing Address - Fax:732-341-2210
Practice Address - Street 1:517 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6757
Practice Address - Country:US
Practice Address - Phone:732-341-4900
Practice Address - Fax:732-341-2210
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00450900111N00000X
246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ594954Medicare PIN