Provider Demographics
NPI:1770037863
Name:RADEBOLDTI, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:RADEBOLDTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 LOCKMAN AVE
Mailing Address - Street 2:APT 4C
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1974
Mailing Address - Country:US
Mailing Address - Phone:347-439-1955
Mailing Address - Fax:
Practice Address - Street 1:178 LOCKMAN AVE
Practice Address - Street 2:APT 4C
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1974
Practice Address - Country:US
Practice Address - Phone:347-439-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator