Healthcare Provider Details

I. General information

NPI: 1699847285
Provider Name (Legal Business Name): KATHLEEN M CUDDIHY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 SOUTH ST
NEW PROVIDENCE NJ
07974-1991
US

IV. Provider business mailing address

180 SOUTH ST
NEW PROVIDENCE NJ
07974-1991
US

V. Phone/Fax

Practice location:
  • Phone: 908-771-9824
  • Fax: 908-771-9674
Mailing address:
  • Phone: 908-771-9824
  • Fax: 908-771-9674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA068734
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: