Provider Demographics
NPI:1619051265
Name:RADOMISLI, TIMOTHY EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EVAN
Last Name:RADOMISLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:130 EAST 77TH STREET
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-249-8088
Mailing Address - Fax:212-434-4887
Practice Address - Street 1:130 EAST 77TH STREET
Practice Address - Street 2:12TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-249-8088
Practice Address - Fax:212-434-4887
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY189251207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C23788Medicare UPIN