Basic Information
| Provider Information | |||||||||
| NPI: | 1427478056 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWEN | ||||||||
| FirstName: | BRADY | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 NEW SCOTLAND AVE | ||||||||
| Address2: | DEPARTMENT OF INTERNAL MEDICINE / PEDIATRICS | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122083412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182623095 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1019 NEW LOUDON RD | ||||||||
| Address2: | |||||||||
| City: | COHOES | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120475003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182627500 | ||||||||
| FaxNumber: | 5182627500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2014 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | 293482-01 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 208000000X | 293482-01 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 293482-01 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.