Provider Demographics
NPI:1629869383
Name:RADONCIC, SELMA (APN)
Entity type:Individual
Prefix:MRS
First Name:SELMA
Middle Name:
Last Name:RADONCIC
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PINE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-2209
Mailing Address - Country:US
Mailing Address - Phone:646-736-8016
Mailing Address - Fax:646-736-8016
Practice Address - Street 1:725 RIVER RD STE 52
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1149
Practice Address - Country:US
Practice Address - Phone:201-320-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR26609200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily