Provider Demographics
NPI:1639233083
Name:RADNA, RICHARD JULIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JULIAN
Last Name:RADNA
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 1:2616 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4805
Mailing Address - Country:US
Mailing Address - Phone:718-884-1441
Mailing Address - Fax:
Practice Address - Street 1:1165 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1210
Practice Address - Country:US
Practice Address - Phone:212-427-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120860174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC10862Medicare UPIN
NY54F951Medicare ID - Type Unspecified