Provider Demographics
NPI:1639843170
Name:RADZINSKI, VICTORIA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:
Last Name:RADZINSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 HACKENSACK ST
Mailing Address - Street 2:
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072-1307
Mailing Address - Country:US
Mailing Address - Phone:201-551-7154
Mailing Address - Fax:
Practice Address - Street 1:80 RIVER ST STE 3D
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5619
Practice Address - Country:US
Practice Address - Phone:201-551-7154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00600100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty