Healthcare Provider Details

I. General information

NPI: 1619555620
Provider Name (Legal Business Name): RESEARCH DIAGNOSIS THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 WEST ST STE 318
FORT LEE NJ
07024-5028
US

IV. Provider business mailing address

39 JAMES ST
MONTCLAIR NJ
07042-2913
US

V. Phone/Fax

Practice location:
  • Phone: 646-685-9836
  • Fax: 888-512-2123
Mailing address:
  • Phone: 646-685-9836
  • Fax: 888-512-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: YULI FRADKIN
Title or Position: MD
Credential:
Phone: 646-685-9836