Individual
MICHELLE BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7000 AUSTIN ST STE 202, FOREST HILLS, NY 11375-1022
(631) 385-7780
Mailing address
10 EISENHOWER AVE, BRENTWOOD, NY 11717-3317
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
930586655
GHI
NY
Enumeration date
06/06/2017
Last updated
06/06/2017
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