Provider Demographics
NPI:1932223039
Name:RADICE-POLI, CAROLINE M
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:M
Last Name:RADICE-POLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:M
Other - Last Name:RADICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, CA
Mailing Address - Street 1:1 SHORT HILLS AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2505
Mailing Address - Country:US
Mailing Address - Phone:973-467-4600
Mailing Address - Fax:
Practice Address - Street 1:1 SHORT HILLS AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2505
Practice Address - Country:US
Practice Address - Phone:973-467-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00031300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist