Provider Demographics
NPI:1033150495
Name:CAVALLO, JOSEPH LOUIS (OD PC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LOUIS
Last Name:CAVALLO
Suffix:
Gender:M
Credentials:OD PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:34 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1012
Mailing Address - Country:US
Mailing Address - Phone:973-887-4771
Mailing Address - Fax:973-887-4779
Practice Address - Street 1:34 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-1012
Practice Address - Country:US
Practice Address - Phone:973-887-4771
Practice Address - Fax:973-887-4779
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00524100152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU48919Medicare UPIN
NJCA764276Medicare PIN