Provider Demographics
NPI:1982921219
Name:PERCIVAL A CABALLERO MD PA
Entity type:Organization
Organization Name:PERCIVAL A CABALLERO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERCIVAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-492-2900
Mailing Address - Street 1:15 KIEL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2565
Mailing Address - Country:US
Mailing Address - Phone:973-492-2900
Mailing Address - Fax:
Practice Address - Street 1:15 KIEL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2565
Practice Address - Country:US
Practice Address - Phone:973-492-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02992900207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3059707Medicaid
NJ3059707Medicaid
CA557597Medicare PIN