Provider Demographics
NPI:1720373384
Name:COOMBS, BRADLEY KEVIN (RN, BSN, MSN SRNA)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:KEVIN
Last Name:COOMBS
Suffix:
Gender:M
Credentials:RN, BSN, MSN SRNA
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Mailing Address - Street 1:575 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6102
Mailing Address - Country:US
Mailing Address - Phone:919-882-0795
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:919-793-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-12
Last Update Date:2024-12-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY743009367500000X
NC88335367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered