Provider Demographics
NPI:1043383557
Name:CAVALLO, DANIELLE JANINE (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:JANINE
Last Name:CAVALLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2638
Mailing Address - Country:US
Mailing Address - Phone:908-222-7777
Mailing Address - Fax:908-222-9242
Practice Address - Street 1:8 MOUNTAIN BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-2638
Practice Address - Country:US
Practice Address - Phone:908-222-7777
Practice Address - Fax:908-222-9242
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07520000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI11847Medicare UPIN
NJ081426Medicare PIN