MEDICARE: CASSADA MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1023198207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASSADA MEDICAL LLC

Provider Business Mailing Address
First Line	:	475 HIGHWAY 70
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5897
Country	:	US
Telephone Number	:	732-886-6002
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 HIGHWAY 70
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5897
Country	:	US
Telephone Number	:	732-886-6002
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	HEATHER LEIGH ROBBERSON
Credential	:
Telephone Number	:	732-886-6002

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/22/2020

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