Individual
BRADLEY ELIJAH KOOMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
350 JERICHO TPKE STE 103, JERICHO, NY 11753-1317
(516) 399-5373
Mailing address
85 VIOLET ST, CENTRAL ISLIP, NY 11722-2630
(347) 526-1904
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
013207
NY
Other
Enumeration date
03/11/2024
Last updated
05/27/2025
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