Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 0155761 | NY |
NPI | 1063665628 |
---|---|
Provider Name | Mr. Robert Stephen Radomski |
First Address | Dobbs Ferry, NY 10522-2620 |
Second Address | Dobbs Ferry, NY 10522-2620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 28/10/2008 |