Provider Demographics
NPI:1811093768
Name:BRADY, MARY E (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 SPARTA AVENUE
Mailing Address - Street 2:SUITE 104, #317
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871
Mailing Address - Country:US
Mailing Address - Phone:973-200-6080
Mailing Address - Fax:
Practice Address - Street 1:270 SPARTA AVENUE
Practice Address - Street 2:SUITE 104, #317
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871
Practice Address - Country:US
Practice Address - Phone:973-200-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA063477208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8110808Medicaid
NJG17975Medicare UPIN
NJ8110808Medicaid