Provider Demographics
NPI:1821618968
Name:RADIUS TELEMED, LLC
Entity Type:Organization
Organization Name:RADIUS TELEMED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANI
Authorized Official - Middle Name:
Authorized Official - Last Name:KORYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-294-6209
Mailing Address - Street 1:21 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-1614
Mailing Address - Country:US
Mailing Address - Phone:877-360-1122
Mailing Address - Fax:
Practice Address - Street 1:2 2ND ST PH 4102
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-7028
Practice Address - Country:US
Practice Address - Phone:201-294-6209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty