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Individual
BRADLEY JUSTIN BROOKS
Active
Individual
BRADLEY JUSTIN BROOKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
658252
NY
164W00000X
Licensed Practical Nurse
295277
NY
Other
Enumeration date
07/19/2012
Last updated
07/19/2012
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