Provider Demographics
NPI:1528626488
Name:CADOO MEDICAL PC
Entity type:Organization
Organization Name:CADOO MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CADOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-577-3010
Mailing Address - Street 1:66 PARK STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042
Mailing Address - Country:US
Mailing Address - Phone:973-577-3010
Mailing Address - Fax:973-577-3011
Practice Address - Street 1:66 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-5908
Practice Address - Country:US
Practice Address - Phone:973-577-3010
Practice Address - Fax:973-577-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538460498OtherNPI
NJBCBSOtherHORIZON
NJCIGNAOtherCIGNA
NJCLOVEROtherCLOVER
NJUHCOtherUNITEDHEALTHCARE