1841541612 NPI number — DR. FIONA A RADCLIFFE PH.D.

Table of content: POLLY A BADT P.T. (NPI 1124049689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841541612 NPI number — DR. FIONA A RADCLIFFE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RADCLIFFE
Provider First Name:
FIONA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841541612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17506 DEVONSHIRE RD
Provider Second Line Business Mailing Address:
2E
Provider Business Mailing Address City Name:
JAMAICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11432-2949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-538-6326
Provider Business Mailing Address Fax Number:
718-805-1038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8437 MAIN ST
Provider Second Line Business Practice Location Address:
1
Provider Business Practice Location Address City Name:
BRIARWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11435-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-538-6326
Provider Business Practice Location Address Fax Number:
718-805-1038
Provider Enumeration Date:
09/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  017139-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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