Healthcare Provider Details

I. General information

NPI: 1780392068
Provider Name (Legal Business Name): RADOVIC NP IN ADULT HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 ROUTE 22
PAWLING NY
12564-1200
US

IV. Provider business mailing address

527 ROUTE 22
PAWLING NY
12564-1200
US

V. Phone/Fax

Practice location:
  • Phone: 845-287-4153
  • Fax: 833-791-2165
Mailing address:
  • Phone: 845-287-4153
  • Fax: 833-791-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BILLIE MARIA RADOVIC
Title or Position: NP
Credential: NP
Phone: 845-287-4153