Provider Demographics
NPI:1699246728
Name:ANTHONY, BRADLEY WAYNE (BOCPO)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:WAYNE
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:BOCPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HOPE LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6110
Mailing Address - Country:US
Mailing Address - Phone:903-880-4927
Mailing Address - Fax:
Practice Address - Street 1:813 CARMAN AVE UNIT A
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6447
Practice Address - Country:US
Practice Address - Phone:516-333-7200
Practice Address - Fax:516-333-7277
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist