Provider Demographics
NPI:1053086744
Name:LUCA RADOMILE NP IN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:LUCA RADOMILE NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:LUCA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADOMILE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN
Authorized Official - Phone:914-732-0332
Mailing Address - Street 1:271 CADMAN PLZ E UNIT 24952
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11202-8255
Mailing Address - Country:US
Mailing Address - Phone:914-732-0332
Mailing Address - Fax:347-697-4825
Practice Address - Street 1:271 CADMAN PLZ E # 24952
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1835
Practice Address - Country:US
Practice Address - Phone:914-732-0332
Practice Address - Fax:347-697-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty