Provider Demographics
NPI:1184000150
Name:RADINO, NATALIE (MS, RN, AGNP-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:RADINO
Suffix:
Gender:F
Credentials:MS, RN, AGNP-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, AGNP-C
Mailing Address - Street 1:800 MONTAUK HWY
Mailing Address - Street 2:STE 18
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2128
Mailing Address - Country:US
Mailing Address - Phone:631-521-4710
Mailing Address - Fax:
Practice Address - Street 1:800 MONTAUK HWY STE 18
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2128
Practice Address - Country:US
Practice Address - Phone:631-772-4646
Practice Address - Fax:631-772-2495
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY675281163W00000X
NY309279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No163W00000XNursing Service ProvidersRegistered Nurse