MEDICARE: MRS. PATRICIA KENNEDY MCCAFFERTY RD

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	133V00000X	Registered Dietitian	716886	NJ

General Provider Information

NPI Number	:	1831229764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA KENNEDY MCCAFFERTY RD

Provider Business Mailing Address
First Line	:	3211 DANSKIN RD
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-4411
Country	:	US
Telephone Number	:	732-280-4888
Fax Number	:	732-280-4888

Provider Business Practice Location Address
First Line	:	3211 DANSKIN RD
Second Line	:
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-4411
Country	:	US
Telephone Number	:	732-280-4888
Fax Number	:	732-280-4888

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/08/2007

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