MEDICARE: MS. SUSAN JEAN RADCLIFFE RD, CCN

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	133V00000X	NJ
2	133V00000X	Registered Dietitian		NJ

General Provider Information

NPI Number	:	1982036885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN JEAN RADCLIFFE RD, CCN

Provider Business Mailing Address
First Line	:	59 FURNACE RD
Second Line	:
City	:	CHESTER
State	:	NJ
Zip	:	07930-2077
Country	:	US
Telephone Number	:	908-879-3083
Fax Number	:	908-879-4671

Provider Business Practice Location Address
First Line	:	59 FURNACE RD
Second Line	:
City	:	CHESTER
State	:	NJ
Zip	:	07930-2077
Country	:	US
Telephone Number	:	908-879-3083
Fax Number	:	908-879-4671

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/01/2013

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