Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA07124300 | NJ |
NPI | 1104944263 |
---|---|
Provider Name | Anthony R Cavazos |
First Address | New Providence, NJ 07974-2934 |
Second Address | New Providence, NJ 07974-2934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 07/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0203343 | (05) | NJ |
04-29599 | EVERCARE (01) | |
5221142040 | BCBS OF NJ (01) | |
E92779 | (02) |