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General NPI Number Information
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NPI Number | 1275779894
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Entity Type | Individual
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Provider Name | MIROSLAV RADE RADEVIC M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2009
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 246 INDUSTRIAL WAY W SUITE 2
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City | EATONTOWN
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State | NJ
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Zip | 07724-4240
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Country | US
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Telephone | 732-389-5200
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Fax | 732-389-5299
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Provider Business Mailing Address
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Address Line | 246 INDUSTRIAL WAY WEST SUITE 2
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City | EATONTOWN
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State | NJ
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Zip | 07724
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Country | US
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Telephone | 732-389-5200
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Fax | 732-389-5299
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 25MA08496100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 257993
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License Number State | NY
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