Individual
RUSSELL BRADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
75 LOCUST GRV, HAZLET, NJ 07730-4144
(732) 829-2197
Mailing address
75 LOCUST GRV, HAZLET, NJ 07730-4144
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
09/21/2015
Last updated
09/21/2015
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