Provider Demographics
NPI:1861949695
Name:MEDVEDOVSKIY, RADION
Entity type:Individual
Prefix:MR
First Name:RADION
Middle Name:
Last Name:MEDVEDOVSKIY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 OCEANA DR E APT 2A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6684
Mailing Address - Country:US
Mailing Address - Phone:718-755-1408
Mailing Address - Fax:
Practice Address - Street 1:155 OCEANA DR E APT 2A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6684
Practice Address - Country:US
Practice Address - Phone:718-755-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty
Yes174400000XOther Service ProvidersSpecialist