Provider Demographics
NPI:1437111499
Name:RADEL, EDWARD IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:IRA
Last Name:RADEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 COUDERT PL
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1014
Mailing Address - Country:US
Mailing Address - Phone:201-891-4351
Mailing Address - Fax:
Practice Address - Street 1:20-20 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2319
Practice Address - Country:US
Practice Address - Phone:201-703-0202
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA022174000207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53466Medicare UPIN
13002608XMedicare ID - Type Unspecified