Provider Demographics
NPI:1174976906
Name:RADIANTCARE
Entity type:Organization
Organization Name:RADIANTCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MUNIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-406-4643
Mailing Address - Street 1:418 W 130TH ST
Mailing Address - Street 2:# 36
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:418 W 130TH ST
Practice Address - Street 2:# 36
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7521
Practice Address - Country:US
Practice Address - Phone:917-406-4643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health