Provider Demographics
NPI:1215118765
Name:RADZINSKI, DAVID J
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:RADZINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10118-0110
Mailing Address - Country:US
Mailing Address - Phone:212-868-5790
Mailing Address - Fax:212-868-5826
Practice Address - Street 1:350 FIFTH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10118
Practice Address - Country:US
Practice Address - Phone:212-868-5790
Practice Address - Fax:212-868-5826
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist