Healthcare Provider Details

I. General information

NPI: 1770938516
Provider Name (Legal Business Name): M CAJULIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ANDOVER PL
BLOOMFIELD NJ
07003-4402
US

IV. Provider business mailing address

914 WYNNEWOOD RD 4M
PELHAM NY
10803-3050
US

V. Phone/Fax

Practice location:
  • Phone: 973-902-5613
  • Fax: 973-893-8142
Mailing address:
  • Phone: 914-233-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number112424
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIA ASUNCION MORALES
Title or Position: OFFICER
Credential: RDCS
Phone: 914-233-7280