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General NPI Number Information
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NPI Number | 1972885952
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Entity Type | Organization
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Legal Business Name | CAVALLARO FAMILY PRACTICE
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 701 WHITE HORSE RD SUITE 4
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City | VOORHEES
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State | NJ
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Zip | 08043-2494
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Country | US
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Telephone | 853-232-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 701 WHITE HORSE RD SUITE 4
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City | VOORHEES
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State | NJ
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Zip | 08043-2494
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Country | US
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Telephone | 853-232-3005
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JOSEPH CAVALLARO
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Credential | DO
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Telephone | 856-232-3005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MB07580400
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License Number State | NJ
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