Provider Demographics
NPI:1982036885
Name:RADCLIFFE, SUSAN JEAN (RD, CCN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JEAN
Last Name:RADCLIFFE
Suffix:
Gender:F
Credentials:RD, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 FURNACE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2077
Mailing Address - Country:US
Mailing Address - Phone:908-879-3083
Mailing Address - Fax:908-879-4671
Practice Address - Street 1:59 FURNACE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2077
Practice Address - Country:US
Practice Address - Phone:908-879-3083
Practice Address - Fax:908-879-4671
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ133V00000X133V00000X
NJ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered