Healthcare Provider Details

I. General information

NPI: 1215401641
Provider Name (Legal Business Name): BARBARA A CAVALLARO, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 12/08/2019
Certification Date: 12/08/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ESSEX ST STE 402
HACKENSACK NJ
07601-3246
US

IV. Provider business mailing address

PO BOX 1140
WARWICK NY
10990-8140
US

V. Phone/Fax

Practice location:
  • Phone: 201-301-2772
  • Fax:
Mailing address:
  • Phone: 201-688-0823
  • Fax: 845-544-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1821058629
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerINDIVIDUAL NPI
# 2
Identifier10697325
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH

VIII. Authorized Official

Name: KENNETH MCGRAW
Title or Position: ADMINISTRATOR
Credential:
Phone: 201-688-0823