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General NPI Number Information
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NPI Number | 1548389877
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Entity Type | Organization
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Legal Business Name | THE CARDIO-THORACIC SURGICAL GROUP, PA
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 35 CLYDE RD SUITE # 104
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City | SOMERSET
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State | NJ
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Zip | 08873-5033
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Country | US
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Telephone | 732-247-3002
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Fax | 732-846-3819
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Provider Business Mailing Address
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Address Line | 35 CLYDE RD SUITE # 104
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City | SOMERSET
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State | NJ
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Zip | 08873-5033
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Country | US
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Telephone | 732-247-3002
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Fax | 732-846-3819
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT JOSEPH CACCAVALE
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Credential | M.D.
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Telephone | 732-247-3002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 208G00000X
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License Number State | NJ
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