Provider Demographics
NPI:1588667885
Name:DAVIDSON, PATRICIA A (DCN,RD,CDE)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DCN,RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2520
Mailing Address - Country:US
Mailing Address - Phone:973-759-9000
Mailing Address - Fax:973-759-2487
Practice Address - Street 1:433 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2520
Practice Address - Country:US
Practice Address - Phone:973-759-9000
Practice Address - Fax:973-759-2487
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ683031133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ436786Medicare ID - Type Unspecified
NJ065588A3WMedicare UPIN