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MR. RANDAL STUART FEDORUK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OT

Contact information

Practice address
65 BERGEN ST, NEWARK, NJ 07107-3001
(973) 972-0186
Mailing address
530 MOOSE HILL RD, GUILFORD, CT 06437-4337
(917) 279-0906
(203) 286-1688

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
TR4600247500
NJ

Other

Enumeration date
05/24/2007
Last updated
07/08/2007
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