Genell Lorencia Bradley

NPI #1790030930 in Freeport, New York

Provider Information

NPI Number: 1790030930
Entity Type: Individual
Name: Genell Lorencia Bradley
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Enumeration Date: Jul 13, 2012
Last Updated: Jul 13, 2012

Practice Location

Address: 111 WOODSIDE AVE
City: Freeport
State: New York
ZIP Code: 11520-1236
Phone: (516) 425-4853

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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