Provider Demographics
NPI:1083980460
Name:BRADLEY, KRISTEN JILL (RD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JILL
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 ANDRE HILL
Mailing Address - Street 2:
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647
Mailing Address - Country:US
Mailing Address - Phone:917-578-5079
Mailing Address - Fax:201-768-4629
Practice Address - Street 1:437 ANDRE HL
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1300
Practice Address - Country:US
Practice Address - Phone:917-578-5079
Practice Address - Fax:201-768-4629
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered