Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | NY | |
Y | 222Z00000X | Podiatrist | NY | |
N | 224P00000X | Prosthetist | NY |
NPI | 1134459886 |
---|---|
Provider Name | Kenneth Radner |
First Address | Smithtown, NY 11787-3022 |
Second Address | East Meadow, NY 11554-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2009 |
Last Update Date | 30/01/2014 |