Provider Demographics
NPI:1134285422
Name:RADIN, AUDREY B
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:B
Last Name:RADIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5439
Mailing Address - Country:US
Mailing Address - Phone:855-619-4448
Mailing Address - Fax:732-784-9918
Practice Address - Street 1:80 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5439
Practice Address - Country:US
Practice Address - Phone:855-619-4448
Practice Address - Fax:732-784-9918
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA-57919207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA-57919OtherSTATE LICENSE
NJMA-57919OtherSTATE LICENSE