1528626488 NPI number — CADOO MEDICAL PC

Table of content: (NPI 1528626488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528626488 NPI number — CADOO MEDICAL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CADOO MEDICAL PC
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:
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:
1528626488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 PARK STREET
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MONTCLAIR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-577-3010
Provider Business Mailing Address Fax Number:
973-577-3011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTCLAIR
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07042-5908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-577-3010
Provider Business Practice Location Address Fax Number:
973-577-3011
Provider Enumeration Date:
06/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CADOO
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
973-577-3010

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1538460498 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: BCBS . This is a "HORIZON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: CIGNA . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: CLOVER . This is a "CLOVER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: UHC . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com