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General NPI Number Information
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NPI Number | 1932452158
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Entity Type | Individual
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Provider Name | JOSEPH RADICH PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 2513 S DIXIE HWY
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-7917
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Country | US
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Telephone | 561-331-2983
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Fax |
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Provider Business Mailing Address
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Address Line | 636 FERN ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5712
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Country | US
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Telephone | 845-863-4400
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.008904
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA59144
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001012360
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 016134-1
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9106969
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License Number State | FL
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