Provider Demographics
NPI:1205940210
Name:PERRY, BRADFORD BENTON (MD)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:BENTON
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 CENTRAL AVENUE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1102
Mailing Address - Country:US
Mailing Address - Phone:914-472-2167
Mailing Address - Fax:914-472-2097
Practice Address - Street 1:455 CENTRAL AVENUE
Practice Address - Street 2:SUITE 214
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1102
Practice Address - Country:US
Practice Address - Phone:914-472-2167
Practice Address - Fax:914-472-2097
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1628032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01064020Medicaid
NYP558687OtherOXFORD
NY109817OtherMHN
NY147571OtherVALUE OPTIONS
NY01064020Medicaid
NY109817OtherMHN