Provider Demographics
NPI:1801996954
Name:BRADY, FRANCIS JOSEPH JR (DPM)
Entity type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:JOSEPH
Last Name:BRADY
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:JOSEPH
Other - Last Name:BRADY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:470 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4153
Mailing Address - Country:US
Mailing Address - Phone:973-669-1119
Mailing Address - Fax:973-669-1031
Practice Address - Street 1:470 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4153
Practice Address - Country:US
Practice Address - Phone:973-669-1119
Practice Address - Fax:973-669-1031
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00121800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3136302Medicaid
NJ121035Medicare PIN
NJ0405160002Medicare NSC
T44720Medicare UPIN