Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 25MA05016600 | NJ |
N | 2086S0129X | Vascular Surgeon | 25MA05016600 | NJ |
NPI | 1801874649 |
---|---|
Provider Name | John S Radomski |
First Address | Marlton, NJ 08053-4197 |
Second Address | Camden, NJ 08103-3109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5094208 | (05) | NJ |
C33229 | (02) |