Provider Demographics
NPI:1780392068
Name:RADOVIC NP IN ADULT HEALTH PLLC
Entity type:Organization
Organization Name:RADOVIC NP IN ADULT HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:RADOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:845-287-4153
Mailing Address - Street 1:93 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:NY
Mailing Address - Zip Code:12531-5448
Mailing Address - Country:US
Mailing Address - Phone:845-287-4153
Mailing Address - Fax:833-791-2165
Practice Address - Street 1:93 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:HOLMES
Practice Address - State:NY
Practice Address - Zip Code:12531-5448
Practice Address - Country:US
Practice Address - Phone:845-287-4153
Practice Address - Fax:833-791-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty