Healthcare Provider Details

I. General information

NPI: 1154305969
Provider Name (Legal Business Name): ALLEN ROBERT RADIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 10/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E 81ST ST SUITE 1
NEW YORK NY
10028-0248
US

IV. Provider business mailing address

50 E 81ST ST SUITE 1
NEW YORK NY
10028-0248
US

V. Phone/Fax

Practice location:
  • Phone: 212-289-6855
  • Fax: 212-584-9573
Mailing address:
  • Phone: 212-289-6855
  • Fax: 212-584-9573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number137910
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: