Provider Demographics
NPI:1174884993
Name:BRADY, SUZANNE J
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:J
Last Name:BRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 BOWERY
Mailing Address - Street 2:2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2853
Mailing Address - Country:US
Mailing Address - Phone:917-733-6821
Mailing Address - Fax:212-358-9996
Practice Address - Street 1:199 BOWERY
Practice Address - Street 2:2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2853
Practice Address - Country:US
Practice Address - Phone:917-733-6821
Practice Address - Fax:212-358-9996
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist