Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 021847 | NY |
NPI | 1043710098 |
---|---|
Provider Name | Allison Rae Radka |
First Address | Depew, NY 14043-4506 |
Second Address | Buffalo, NY 14203-1021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2018 |
Last Update Date | 16/02/2018 |