Healthcare Provider Details

I. General information

NPI: 1265986426
Provider Name (Legal Business Name): ALYCE H CUDJOE MA, RD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FARRINGTON ST
VAUXHALL NJ
07088-1307
US

IV. Provider business mailing address

17 WATSON AVE
EAST ORANGE NJ
07018-3303
US

V. Phone/Fax

Practice location:
  • Phone: 256-652-5641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: