MEDICARE: RADCLIFF SPINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician

General Provider Information

NPI Number	:	1285378885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADCLIFF SPINE

Provider Business Mailing Address
First Line	:	415 NEW RD STE 3
Second Line	:
City	:	SOMERS POINT
State	:	NJ
Zip	:	08244-2106
Country	:	US
Telephone Number	:	609-800-3472
Fax Number	:	609-800-3472

Provider Business Practice Location Address
First Line	:	415 NEW RD STE 3
Second Line	:
City	:	SOMERS POINT
State	:	NJ
Zip	:	08244-2106
Country	:	US
Telephone Number	:	609-800-3472
Fax Number	:	609-800-3472

Authorized Official
Title or Position	:	CEO
Name	:	KRISTEN E RADCLIFF
Credential	:	MD
Telephone Number	:	609-800-3472

Provider Enumeration Date	:	04/21/2022
Last Update Date	:	08/02/2022

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Directions to “RADCLIFF SPINE ” Practice Location

Language	Start Address	Practice Location

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