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General NPI Number Information
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NPI Number | 1376540484
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Entity Type | Individual
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Provider Name | JAMES P. CAVANAGH MD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 200 BELLE TERRE RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1928
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Country | US
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Telephone | 631-474-6205
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Fax | 631-476-5602
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Provider Business Mailing Address
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Address Line | 200 BELLE TERRE RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1928
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Country | US
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Telephone | 631-474-6205
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Fax | 631-476-5602
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 210488-1
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License Number State | NY
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