Provider Demographics
NPI:1871964031
Name:RADZIK, HADASSA
Entity type:Individual
Prefix:
First Name:HADASSA
Middle Name:
Last Name:RADZIK
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 1:2520 KINGS HWY
Mailing Address - Street 2:APT 5D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1766
Mailing Address - Country:US
Mailing Address - Phone:718-614-1310
Mailing Address - Fax:
Practice Address - Street 1:2520 KINGS HWY
Practice Address - Street 2:APT 5D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1766
Practice Address - Country:US
Practice Address - Phone:718-614-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039119-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039119-1OtherLICENSE#