Provider Demographics
NPI:1306523717
Name:BRADLEY, MOLLIE (PA)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:135 N LOVETT AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1402
Mailing Address - Country:US
Mailing Address - Phone:732-693-1392
Mailing Address - Fax:
Practice Address - Street 1:1945 STATE ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-2330
Practice Address - Fax:732-776-2344
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00795000363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant