MEDICARE: JOSEPH A. RADICE III

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	103K00000X	Behavior Analyst	1-20-46019	NJ

General Provider Information

NPI Number	:	1598439481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH A. RADICE III

Provider Business Mailing Address
First Line	:	78 JOHN MILLER WAY
Second Line	:
City	:	KEARNY
State	:	NJ
Zip	:	07032-6500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	78 JOHN MILLER WAY
Second Line	:
City	:	KEARNY
State	:	NJ
Zip	:	07032-6500
Country	:	US
Telephone Number	:	855-500-3848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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