Provider Demographics
NPI:1114921947
Name:CAVALIERI, MORRIS M (MD)
Entity type:Individual
Prefix:
First Name:MORRIS
Middle Name:M
Last Name:CAVALIERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 ERIE RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9306
Mailing Address - Country:US
Mailing Address - Phone:716-947-4851
Mailing Address - Fax:716-947-0413
Practice Address - Street 1:7020 ERIE RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9306
Practice Address - Country:US
Practice Address - Phone:716-947-4851
Practice Address - Fax:716-947-0413
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-06-05
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
NY208623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01632562Medicaid
NY01632562Medicaid
NYG16655Medicare UPIN