Provider Demographics
NPI:1740296938
Name:PATENAUDE, BRADY WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:WILLIAM
Last Name:PATENAUDE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:NY
Mailing Address - Zip Code:12170-0427
Mailing Address - Country:US
Mailing Address - Phone:518-664-4525
Mailing Address - Fax:518-664-1256
Practice Address - Street 1:781 HUDSON AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:STILLWATER
Practice Address - State:NY
Practice Address - Zip Code:12170-0427
Practice Address - Country:US
Practice Address - Phone:518-664-4525
Practice Address - Fax:518-664-1256
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1065577OtherASHN
NY20406141102OtherPRISM HEALTH NETWORK
NYC11152-8BOtherWORKERS' COMPENSATION
NYNY11152OtherMVP HEALTH PLAN
NYX08P21OtherBLUE CROSS/BLUE SHIELD
NY10108516OtherCDPHP
NY204061411OtherLANDMARK HEALTHCARE
NYRA9915Medicare PIN
NYNY11152OtherMVP HEALTH PLAN