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General NPI Number Information
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NPI Number | 1124367941
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Entity Type | Individual
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Provider Name | NOEL E RADWANSKI DVM
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Gender | Female
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Dates
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Enumeration Date | 02/14/2013
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Last Update Date | 05/22/2019
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Provider Practice Location Address
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Address Line | 625 W RIDGE PIKE STE 102
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-1180
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Country | US
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Telephone | 845-677-9994
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Fax | 484-567-7998
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Provider Business Mailing Address
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Address Line | 625 W RIDGE PIKE BLDG B
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-1191
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Country | US
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Telephone | 484-567-7999
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Fax | 845-677-9984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174M00000X
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Taxonomy Name | Veterinarian
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License Number | 29VI00624200
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License Number State | NJ
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