Provider Demographics
NPI:1043239387
Name:RIEDERS, BRADLEY S (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:S
Last Name:RIEDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:210 E SUNRISE HWY
Mailing Address - Street 2:STE 304
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1329
Mailing Address - Country:US
Mailing Address - Phone:516-825-8484
Mailing Address - Fax:516-825-8491
Practice Address - Street 1:210 E SUNRISE HWY
Practice Address - Street 2:STE 304
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1329
Practice Address - Country:US
Practice Address - Phone:516-825-8484
Practice Address - Fax:516-825-8491
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY162517207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01019254Medicaid
NY01019254Medicaid
NYWX1001Medicare ID - Type Unspecified