Provider Demographics
NPI:1972885952
Name:CAVALLARO FAMILY PRACTICE
Entity type:Organization
Organization Name:CAVALLARO FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLARO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-232-3005
Mailing Address - Street 1:701 WHITE HORSE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2494
Mailing Address - Country:US
Mailing Address - Phone:853-232-3005
Mailing Address - Fax:
Practice Address - Street 1:701 WHITE HORSE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2494
Practice Address - Country:US
Practice Address - Phone:853-232-3005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07580400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty