Healthcare Provider Details

I. General information

NPI: 1790164614
Provider Name (Legal Business Name): BRIDGETTE MCCABE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 E JIMMIE LEEDS RD STE 101
GALLOWAY NJ
08205-9599
US

IV. Provider business mailing address

8025 BLACK HORSE PIKE STE 300
PLEASANTVILLE NJ
08232-2962
US

V. Phone/Fax

Practice location:
  • Phone: 609-677-9729
  • Fax: 215-762-7765
Mailing address:
  • Phone: 609-652-8316
  • Fax: 215-762-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT209126
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD474841
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA11663300
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA11663300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: