Provider Demographics
NPI:1063720647
Name:ANDREA CACCIARELLI MD LLC
Entity type:Organization
Organization Name:ANDREA CACCIARELLI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:CACCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-364-0135
Mailing Address - Street 1:251 SOMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-2640
Mailing Address - Country:US
Mailing Address - Phone:973-364-0135
Mailing Address - Fax:973-364-0135
Practice Address - Street 1:29 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3407
Practice Address - Country:US
Practice Address - Phone:973-364-0135
Practice Address - Fax:973-364-0135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty