Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD448521 | PA |
N | 2081S0010X | Sports Medicine | 241308 | NY |
N | 213ES0000X | Sports Medicine | 241308 | NY |
NPI | 1417116039 |
---|---|
Provider Name | Dr. Jeffrey Radecki |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Bethlehem, PA 18017-7334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 28/04/2016 |