Provider Demographics
NPI:1235717075
Name:GEORGIEV, RADI
Entity Type:Individual
Prefix:
First Name:RADI
Middle Name:
Last Name:GEORGIEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4295 WEBSTER AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-2340
Mailing Address - Country:US
Mailing Address - Phone:646-721-4411
Mailing Address - Fax:
Practice Address - Street 1:4295 WEBSTER AVE APT 5C
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-2340
Practice Address - Country:US
Practice Address - Phone:646-724-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016145225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist