Individual
BRAD EVAN MULLIGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
37 TIMBER RIDGE DR, COMMACK, NY 11725-1739
(631) 889-1116
Mailing address
37 TIMBER RIDGE DR, COMMACK, NY 11725-1739
(631) 889-1116
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
024452
NY
Other
Enumeration date
03/12/2020
Last updated
03/12/2020
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