1235451790 NPI number — ROMEO A CABALLES JR MD PA

Table of content: (NPI 1235451790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235451790 NPI number — ROMEO A CABALLES JR MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROMEO A CABALLES JR MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1235451790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 OLD SCHOOLHOUSE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASBURY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08802-1210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-203-0022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 LAMINGTON RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BRANCHBURG
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08876-3374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-203-0022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CABALLES
Authorized Official First Name:
ROMEO
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
908-203-0022

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  25MA07101700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8289301 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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