Provider Demographics
NPI:1992893127
Name:RADWANER, BRADLEY ARDEN (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ARDEN
Last Name:RADWANER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E. 57TH ST.
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-717-0666
Mailing Address - Fax:212-717-2399
Practice Address - Street 1:136 E. 57TH ST.
Practice Address - Street 2:SUITE 1001
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-717-0666
Practice Address - Fax:212-717-2399
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150577207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBR078A9110OtherBCBS
NY00896117Medicaid
060015803Medicare PIN
NYB42279Medicare UPIN
NY00896117Medicaid