Provider Demographics
NPI:1477332468
Name:BUSICK, CECILIA WOODLYN (RD)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:WOODLYN
Last Name:BUSICK
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 1:6057 CATALPA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5104
Mailing Address - Country:US
Mailing Address - Phone:860-462-3313
Mailing Address - Fax:
Practice Address - Street 1:6057 CATALPA AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5104
Practice Address - Country:US
Practice Address - Phone:860-462-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered